TY - JOUR
T1 - Characterizing non-linear effects of hospitalisation duration on antimicrobial resistance in respiratory isolates
T2 - an analysis of a prospective nationwide surveillance system
AU - the Swiss Centre for Antibiotic resistance (ANRESIS)
AU - Sommerstein, R.
AU - Atkinson, A.
AU - Lo Priore, E. F.
AU - Kronenberg, A.
AU - Marschall, J.
AU - Burnens, A.
AU - Cherkaoui, A.
AU - Dubuis, O.
AU - Egli, A.
AU - Gaia, V.
AU - Koch, D.
AU - Leib, S. L.
AU - Luyet, S.
AU - Nordmann, P.
AU - Perreten, V.
AU - Piffaretti, J. C.
AU - Prod'hom, G.
AU - Schrenzel, J.
AU - Widmer, A. F.
AU - Zanetti, G.
AU - Zbinden, R.
N1 - Funding Information:
There are no conflicts of interest to declare. For development and support of the ANRESIS database we obtained financial support from the Swiss National Science Foundation , the Swiss Federal Office of Public Health , the Swiss Conference of the Cantonal Ministers of Public Health and the University of Bern .
Funding Information:
There are no conflicts of interest to declare. For development and support of the ANRESIS database we obtained financial support from the Swiss National Science Foundation, the Swiss Federal Office of Public Health, the Swiss Conference of the Cantonal Ministers of Public Health and the University of Bern.
Publisher Copyright:
© 2017 European Society of Clinical Microbiology and Infectious Diseases
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objectives Our objective was to systematically study the influence of length of hospital stay on bacterial resistance in relevant respiratory tract isolates. Methods Using prospective epidemiological data from the National Swiss Antibiotic Resistance Surveillance System, susceptibility testing results for respiratory isolates retrospectively retrieved from patients hospitalised between 2008 and 2014 were compiled. Generalized additive models were used to illustrate resistance rates relative to hospitalisation duration and to adjust for co-variables. Results In all, 19 622 isolates of six relevant and predominant species were included. Resistance patterns for the predominant species showed a species-specific and antibiotic-resistance-specific profile in function of hospitalisation duration. The oxacillin resistance profile in Staphylococcus aureus isolates was constantly increasing (monophasic). The pattern of resistance to cefepime in Pseudomonas aeruginosa was biphasic with a decreasing resistance rate for the first 5 days of hospitalisation and an increase for days 6–30. A different biphasic pattern occurred in Escherichia coli regarding amoxicillin-clavulanic acid resistance: odds/day increased for the first 7 days of hospitalisation and then remained stable for days 8–30. In the adjusted models epidemiological characteristics such as age, ward type, hospital type and linguistic region were identified as relevant co-variables for the resistance rates. The contribution of these confounders was specific to the individual species/antibiotic resistance models. Conclusions Resistance rates do not follow a dichotomic pattern (early versus late nosocomial) as suggested by current hospital-acquired pneumonia treatment guidelines. Duration of hospitalisation rather appears to have a more complex and non-linear relationship with bacterial resistance in hospital-acquired pneumonia, also depending on host and environmental factors.
AB - Objectives Our objective was to systematically study the influence of length of hospital stay on bacterial resistance in relevant respiratory tract isolates. Methods Using prospective epidemiological data from the National Swiss Antibiotic Resistance Surveillance System, susceptibility testing results for respiratory isolates retrospectively retrieved from patients hospitalised between 2008 and 2014 were compiled. Generalized additive models were used to illustrate resistance rates relative to hospitalisation duration and to adjust for co-variables. Results In all, 19 622 isolates of six relevant and predominant species were included. Resistance patterns for the predominant species showed a species-specific and antibiotic-resistance-specific profile in function of hospitalisation duration. The oxacillin resistance profile in Staphylococcus aureus isolates was constantly increasing (monophasic). The pattern of resistance to cefepime in Pseudomonas aeruginosa was biphasic with a decreasing resistance rate for the first 5 days of hospitalisation and an increase for days 6–30. A different biphasic pattern occurred in Escherichia coli regarding amoxicillin-clavulanic acid resistance: odds/day increased for the first 7 days of hospitalisation and then remained stable for days 8–30. In the adjusted models epidemiological characteristics such as age, ward type, hospital type and linguistic region were identified as relevant co-variables for the resistance rates. The contribution of these confounders was specific to the individual species/antibiotic resistance models. Conclusions Resistance rates do not follow a dichotomic pattern (early versus late nosocomial) as suggested by current hospital-acquired pneumonia treatment guidelines. Duration of hospitalisation rather appears to have a more complex and non-linear relationship with bacterial resistance in hospital-acquired pneumonia, also depending on host and environmental factors.
KW - Antimicrobial resistance
KW - Hospital-acquired pneumonia
KW - Hospitalisation duration
KW - Respiratory tract
KW - Surveillence
UR - http://www.scopus.com/inward/record.url?scp=85023644612&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2017.05.018
DO - 10.1016/j.cmi.2017.05.018
M3 - Article
C2 - 28559001
AN - SCOPUS:85023644612
SN - 1198-743X
VL - 24
SP - 45
EP - 52
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 1
ER -