title: Association between antimicrobial consumption and resistance in Escherichia coli.
abstract: During a 9-year study period from 1997 through 2005, the association between antimicrobial resistance rates in Escherichia coli and outpatient antimicrobial consumption was investigated in 20 hospital districts in Finland. A total of 754,293 E. coli isolates, mainly from urine samples, were tested for antimicrobial resistance in 26 clinical microbiology laboratories. The following antimicrobials were studied: ampicillin, amoxicillin-clavulanate, cephalosporins, fluoroquinolones, trimethoprim, trimethoprim-sulfamethoxazole, pivmecillinam, and nitrofurantoin. We applied a protocol used in earlier studies in which the level of antimicrobial consumption over 1 year was compared with the level of resistance in the next year. Statistically significant associations were found for nitrofurantoin use versus nitrofurantoin resistance (P < 0.0001), cephalosporin use versus nitrofurantoin resistance (P = 0.0293), amoxicillin use versus fluoroquinolone resistance (P = 0.0031), and fluoroquinolone use versus ampicillin resistance (P = 0.0046). Interestingly, we found only a few associations between resistance and antimicrobial consumption. The majority of the associations studied were not significant, including the association between fluoroquinolone use and fluoroquinolone resistance.
authors.affiliation: Department of Bacterial and Inflammatory Diseases, Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland. miika.bergman@ktl.fi
authors.forename: Miika
authors.initials: M
authors.lastname: Bergman
authors.forename: Solja T
authors.initials: ST
authors.lastname: Nyberg
authors.forename: Pentti
authors.initials: P
authors.lastname: Huovinen
authors.forename: Pirkko
authors.initials: P
authors.lastname: Paakkari
authors.forename: Antti J
authors.initials: AJ
authors.lastname: Hakanen
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000561:Amdinocillin Pivoxil / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D005387:Finland / Q000453:epidemiology; D024841:Fluoroquinolones / Q000627:therapeutic use; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008826:Microbial Sensitivity Tests; D009582:Nitrofurantoin / Q000627:therapeutic use; D012189:Retrospective Studies; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D000561:Amdinocillin Pivoxil; D019980:Amoxicillin-Potassium Clavulanate Combination; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin; D014295:Trimethoprim