Community antibiotic therapy, hospitalization and subsequent respiratory tract isolation of Haemophilus influenzae resistant to amoxycillin: a nested case-control study.
The study objective was to determine whether recent community antibiotic prescribing and hospitalization are associated with beta-lactam resistance in respiratory isolates of Haemophilus influenzae. Data obtained for hospitalization and community prescribing (in the previous 3 months) from 412 adults (>15 years) in whom an episode of respiratory tract infection had been described, during which H. influenzae was isolated, were analysed. Seventy-three (17.7%) isolates of H. influenzae were resistant to amoxycillin. Resistance was associated with recent hospitalization [odds ratio (OR) 3.2, 1.8-5.6] and antibiotic exposure in the community (2.1, 1.2-3.6). These variables were independently associated with amoxycillin resistance [hospitalization (OR 4.5, 1. 7-12.5) and community beta-lactam antibiotic exposure (3.9, 1.6-9. 8)]. Hospitalized patients probably received antibiotics during their admission although aquisition of the organism or the beta-lactamase via plasmids from other Gram-negative organisms in the hospital could also be a factor. Control measures to reduce the inappropriate use of antimicrobials in the community and in hospital need to be reinforced.
Seaton
R A
RA
Infection and Immunodeficiency Unit, Tayside University Hospitals NHS Trust, Kings Cross Hospital, Scotland, UK.
Steinke
D T
DT
Phillips
G
G
MacDonald
T
T
Davey
P G
PG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D006192:Haemophilus Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D010403:Penicillin Resistance; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
D000900:Anti-Bacterial Agents