Impact of antibiotic usage on extended-spectrum β-lactamase producing Escherichia coli prevalence

Abstract

An increase in antibiotic usage is considered to contribute to the emergence of antimicrobial resistance. Although experts are counting on the antimicrobial stewardship programs to reduce antibiotic usage, their effect remains uncertain. In this study, we aimed to evaluate the impact of antibiotic usage and forecast the prevalence of hospital-acquired extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) using time-series analysis. Antimicrobial culture information of E. coli was obtained using a text processing technique that helped extract free-text electronic health records from standardized data. The antimicrobial use density (AUD) of antibiotics of interest was used to estimate the quarterly antibiotic usage. Transfer function model was applied to forecast relationship between antibiotic usage and ESBL-producing E. coli. Of the 1938 hospital-acquired isolates, 831 isolates (42.9%) were ESBL-producing E. coli. Both the proportion of ESBL-producing E. coli and AUD increased over time. The transfer model predicted that ciprofloxacin AUD is related to the proportion of ESBL-producing E. coli two quarters later. In conclusion, excessive use of antibiotics was shown to affect the prevalence of resistant organisms in the future. Therefore, the control of antibiotics with antimicrobial stewardship programs should be considered to restrict antimicrobial resistance.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Flow diagram depicting the study population.

Figure 2

Time-series plot of ESBL-producing E. coli proportion and AUD from 1 January 2012 to 30 June 2019. AUD of (A) ciprofloxacin, (B) cefepime, (C) piperacillin-tazobactam and (D) third-generation cephalosporin.

Figure 3

Predicted and observed ESBL-producing E. coli proportion upon ciprofloxacin usage.