title: Systematic analysis of the relationship between antibiotic use and extended-spectrum beta-lactamase resistance in Enterobacteriaceae in a French hospital: a time series analysis.
abstract: The influence of hospital use of antibiotics other than cephalosporins and fluoroquinolones on extended-spectrum beta-lactamase (ESBL) resistance among Enterobacteriaceae is poorly known. Our objective was to explore the association between ESBL and hospital use of various classes of antibacterial agents. The relationship between monthly use of 19 classes of antibacterial agents and incidence of nosocomial ESBL-producing Enterobacteriaceae in a French hospital was studied between 2007 and 2013. Five antibiotic classes were significantly and independently associated with ESBL resistance. Uses of tetracyclines (link estimate ± SE, 0.0066 ± 0.0033), lincosamides (0.0093 ± 0.0029), and other antibacterial agents (0.0050 ± 0.0023) were associated with an increased incidence, while nitrofurantoin (-0.0188 ± 0.0062) and ticarcillin and piperacillin with or without enzyme inhibitor (-0.0078 ± 0.0031) were associated with a decreased incidence. In a multivariate model including 3rd- and 4th-generation cephalosporins, fluoroquinolones, amoxicillin, and amoxicillin-clavulanate, 3rd- and 4th-generation cephalosporins (0.0019 ± 0.0009) and fluoroquinolones (0.0020 ± 0.0008) were associated with an increased ESBL resistance, whereas amoxicillin and amoxicillin-clavulanate were not. Hospital use of tetracyclines and lincosamides may promote ESBL resistance in Enterobacteriaceae. Nitrofurantoin and ticarcillin and piperacillin with or without enzyme inhibitor should be considered as potential alternatives to broad-spectrum cephalosporins and fluoroquinolones to control the diffusion of ESBL resistance.
authors.affiliation: INSERM, U657 Pharmaco-épidémiologie et évaluation de l'impact des produits de santé sur les populations, Paris, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Vibet
authors.affiliation: EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Roux
authors.affiliation: EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France.|Emergency Department, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Montassier
authors.affiliation: EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France.|Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Corvec
authors.affiliation: Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: M-E
authors.initials: ME
authors.lastname: Juvin
authors.affiliation: Health Information Management Department, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Ngohou
authors.affiliation: EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France.|Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: D
authors.initials: D
authors.lastname: Lepelletier
authors.affiliation: EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France. eric.batard@univ-nantes.fr.|Emergency Department, Centre Hospitalier Universitaire de Nantes, Nantes, France. eric.batard@univ-nantes.fr.
authors.forename: E
authors.initials: E
authors.lastname: Batard
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D004755:Enterobacteriaceae / Q000187:drug effects*; D005602:France; D006801:Humans; D008826:Microbial Sensitivity Tests; D013997:Time Factors; D018440:beta-Lactam Resistance / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents