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Antimicrobial drug use and resistance in Europe.

van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M, European Antimicrobial Resistance Surveillance System GroupEuropean Surveillance of Antimicrobial Consumption Project Gro - Emerging Infect. Dis. (2008)

Bottom Line: The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level.Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations.Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Public Health and the Environment, Bilthoven, the Netherlands.

ABSTRACT
Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000-2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.

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Related in: MedlinePlus

Occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) plotted against outpatient use of penicillins in 17 European countries including 95% confidence intervals. DID, defined daily doses per 1,000 inhabitants. See Table 1 footnote for country designations.
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Figure 3: Occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) plotted against outpatient use of penicillins in 17 European countries including 95% confidence intervals. DID, defined daily doses per 1,000 inhabitants. See Table 1 footnote for country designations.

Mentions: The occurrence of PNSP in European countries correlated with the country-specific use of penicillins, which explained 61% of the observed variance (p<0.01) (Figure 3). The second best correlation was provided by the total antimicrobial drug use in ambulatory care, which explained 46% of the observed variance (p<0.01). Both associations were robust and remained significant, regardless of the interval between the ascertainment of antimicrobial drug use and the recording of antimicrobial resistance. A notably less consistent association was found when we correlated the use of MLS-class antimicrobial agents or fluoroquinolones with the occurrence of PNSP (Table 3). ENSP occurrence in Europe correlated most compellingly with the country-specific use rate of ATC category J01D (other β-lactams), which explained 48% of the observed variance (p<0.01) (Table 3). However, this effect appeared to be confounded by the use of MLS-class antimicrobial agents and fluoroquinolones. By fitting use data for these antimicrobial agents into the model, the effect estimates for the former decreased by 40% (Table 4), indicating that part of the effect attributed to the use of other β-lactam antimicrobial agents appeared to be exerted by MLS-class antimicrobial agents and fluoroquinolones.


Antimicrobial drug use and resistance in Europe.

van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma E, Monen J, Goossens H, Ferech M, European Antimicrobial Resistance Surveillance System GroupEuropean Surveillance of Antimicrobial Consumption Project Gro - Emerging Infect. Dis. (2008)

Occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) plotted against outpatient use of penicillins in 17 European countries including 95% confidence intervals. DID, defined daily doses per 1,000 inhabitants. See Table 1 footnote for country designations.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2630720&req=5

Figure 3: Occurrence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) plotted against outpatient use of penicillins in 17 European countries including 95% confidence intervals. DID, defined daily doses per 1,000 inhabitants. See Table 1 footnote for country designations.
Mentions: The occurrence of PNSP in European countries correlated with the country-specific use of penicillins, which explained 61% of the observed variance (p<0.01) (Figure 3). The second best correlation was provided by the total antimicrobial drug use in ambulatory care, which explained 46% of the observed variance (p<0.01). Both associations were robust and remained significant, regardless of the interval between the ascertainment of antimicrobial drug use and the recording of antimicrobial resistance. A notably less consistent association was found when we correlated the use of MLS-class antimicrobial agents or fluoroquinolones with the occurrence of PNSP (Table 3). ENSP occurrence in Europe correlated most compellingly with the country-specific use rate of ATC category J01D (other β-lactams), which explained 48% of the observed variance (p<0.01) (Table 3). However, this effect appeared to be confounded by the use of MLS-class antimicrobial agents and fluoroquinolones. By fitting use data for these antimicrobial agents into the model, the effect estimates for the former decreased by 40% (Table 4), indicating that part of the effect attributed to the use of other β-lactam antimicrobial agents appeared to be exerted by MLS-class antimicrobial agents and fluoroquinolones.

Bottom Line: The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level.Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations.Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Public Health and the Environment, Bilthoven, the Netherlands.

ABSTRACT
Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000-2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.

Show MeSH
Related in: MedlinePlus