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Impact of Different Methods for Describing the Extent of Prior Antibiotic Exposure on the Association Between Antibiotic Use and Antibiotic-Resistant Infection

Published online by Cambridge University Press:  02 January 2015

Emily P. Hyle ,
Warren B. Bilker ,
Leanne B. Gasink  and
Ebbing Lautenbach
Emily P. Hyle
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Warren B. Bilker
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
Leanne B. Gasink
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
Ebbing Lautenbach*
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104-6021 (elautenb@mail.med.upenn.edu)
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Abstract

Objective.

Many studies have investigated the association between prior antibiotic use and antibiotic resistance. However, methods used in past studies to describe the extent of prior antibiotic use (eg, use of the 2 categories exposure versus no exposure and measurement of duration of exposure) have not been reviewed. The impact of the use of different methods for quantifying the use of antibiotics is unknown. The objectives of this study were to characterize past approaches to describing the extent of antibiotic use and to identify the impact of the use of different methods on associations between use of specific antibiotics and infection with an antibiotic-resistant-organism.

Methods.

We conducted a systematic review of studies that investigated risk factors for extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species to identify variability in past approaches to describing the extent of antibiotic use. We then reanalyzed a data set from a prior study of risk factors for infection with ESBL-producing E. coli and Klebsiella species. We developed 2 separate multivariable models: 1 in which prior antibiotic use was described as a categorical variable (eg, exposure or no exposure) and 1 in which antibiotic use was described as a continuous variable (eg, measured in antibiotic-days). These models were compared qualitatively.

Setting.

Large academic medical center.

Results.

The 25 articles included in the systematic review revealed a variety of methods used to describe the extent of prior antibiotic exposure. Only 1 study justified its approach. Results from the 2 multivariable models that used different methodologic approaches differed substantially. Specifically, use of third-generation cephalosporins was a risk factor for infection with ESBL-producing E. coli and Klebsiella species when antibiotic use was described as a continuous variable but not when antibiotic use was described as a categorical variable.

Conclusions.

There has been no consistent method for assessing the extent of prior antibiotic exposure. The use of different methods may substantially alter the identified antimicrobial risk factors, which has important implications for the resultant interventions regarding antimicrobial use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 647 - 654
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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