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Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System

Published online by Cambridge University Press:  05 January 2017

Rebecca L. Pedela ,
Katherine C. Shihadeh ,
Bryan C. Knepper ,
Michelle K. Haas ,
William J. Burman  and
Timothy C. Jenkins
Rebecca L. Pedela
Affiliation:
Denver Health, Denver, Colorado
Katherine C. Shihadeh
Affiliation:
Denver Health, Denver, Colorado
Bryan C. Knepper
Affiliation:
Denver Health, Denver, Colorado
Michelle K. Haas
Affiliation:
Denver Health, Denver, Colorado University of Colorado School of Medicine, Aurora, Colorado Denver Public Health, Denver, Colorado
William J. Burman
Affiliation:
Denver Health, Denver, Colorado University of Colorado School of Medicine, Aurora, Colorado
Timothy C. Jenkins*
Affiliation:
Denver Health, Denver, Colorado University of Colorado School of Medicine, Aurora, Colorado
*
Address correspondence to Timothy Jenkins, MD, Denver Health, 660 Bannock Street, Denver, Colorado 80204 (timothy.jenkins@dhha.org).
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Abstract

OBJECTIVES

To evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among E. coli isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis.

DESIGN

Retrospective preintervention–postintervention study.

SETTING

Urban, integrated healthcare system.

PATIENTS

Adult outpatients treated for acute cystitis.

METHODS

We compared 2 time periods: January 2003–June 2007 when FQs were recommended as first-line therapy, and July 2007–December 2012, when NFT was recommended. The main outcomes were changes in FQ and NFT use and FQ- and NFT-resistant E. coli by time-series analysis.

RESULTS

Overall, 5,714 adults treated for acute cystitis and 11,367 outpatient E. coli isolates were included in the analysis. After the change in prescribing guidance, there was an immediate 26% (95% CI, 20%–32%) decrease in FQ use (P<.001), and a nonsignificant 6% (95% CI, −2% to 15%) increase in NFT use (P=.12); these changes were sustained over the postintervention period. Oral cephalosporin use also increased during the postintervention period. There was a significant decrease in FQ-resistant E. coli of −0.4% per quarter (95% CI, −0.6% to −0.1%; P=.004) between the pre- and postintervention periods; however, a change in the trend of NFT-resistant E. coli was not observed.

CONCLUSIONS

In an integrated healthcare system, a change in institutional guidance for acute uncomplicated cystitis was associated with a reduction in FQ use, which may have contributed to a stabilization in FQ-resistant E. coli. Increased nitrofurantoin use was not associated with a change in NFT resistance.

Infect Control Hosp Epidemiol 2017;38:461–468

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 4 , April 2017 , pp. 461 - 468
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: This work was presented in part at IDWeek 2014 on October 9, 2014 in Philadelphia, Pennsylvania.

References

REFERENCES

1. Antibiotic resistance threats in the United States, 2013. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/. Published 2013. Accessed 9 June 2014.Google Scholar
2. National action plan for combating antibiotic-resistant bacteria. The White House website. https://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published March 2015 .Accessed April 6, 2015.Google Scholar
3. Shapiro, DJ, Hicks, LA, Pavia, AT, Hersh, AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09. J Antimicr Chemother 2014;69:234–240.CrossRefGoogle ScholarPubMed
4. Gupta, K, Hooton, TM, Naber, KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103–e120.Google Scholar
5. Lautenbach, E, Strom, BL, Nachamkin, I, et al. Longitudinal trends in fluoroquinolone resistance among Enterobacteriaceae isolates from inpatients and outpatients, 1989–2000: differences in the emergence and epidemiology of resistance across organisms. Clin Infect Dis 2004;38:655–662.Google Scholar
6. Johnson, L, Sabel, A, Burman, WJ, et al. Emergence of fluoroquinolone resistance in outpatient urinary Escherichia coli isolates. Am J Med 2008;121:876–884.Google Scholar
7. Chen, DK, McGeer, A, de Azavedo, JC, Low, DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. N Engl J Med 1999;341:233–239.Google Scholar
8. MacDougall, C, Powell, JP, Johnson, CK, Edmond, MB, Polk, RE. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis 2005;41:435–440.Google Scholar
9. Ambrose, PG, Bast, D, Doern, GV, et al. Fluoroquinolone-resistant Streptococcus pneumoniae, an emerging but unrecognized public health concern: is it time to resight the goalposts? Clin Infect Dis 2004;39:1554–1556.Google Scholar
10. Lautenbach, E, Larosa, LA, Kasbekar, N, Peng, HP, Maniglia, RJ, Fishman, NO. Fluoroquinolone utilization in the emergency departments of academic medical centers: prevalence of, and risk factors for, inappropriate use. Arch Intern Med 2003;163:601–605.CrossRefGoogle ScholarPubMed
11. Stevens, V, Dumyati, G, Fine, LS, Fisher, SG, van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:42–48.CrossRefGoogle ScholarPubMed
12. Slimings, C, Riley, TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicr Chemother 2014;69:881–891.Google Scholar
13. Zilberberg, MD, Reske, K, Olsen, M, Yan, Y, Dubberke, ER. Risk factors for recurrent Clostridium difficile infection (CDI) hospitalization among hospitalized patients with an initial CDI episode: a retrospective cohort study. BMC Infect Dis 2014;14:306.Google Scholar
14. FDA Drug Safety Communication. US Food and Drug Administration website. http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm. Published 2016. Accessed June 10, 2016.Google Scholar
15. Burman, WJ, Breese, PE, Murray, BE, et al. Conventional and molecular epidemiology of trimethoprim-sulfamethoxazole resistance among urinary Escherichia coli isolates. Am J Med 2003;115:358–364.Google Scholar
16. Gabow, P, Eisert, S, Wright, R. Denver Health: a model for the integration of a public hospital and community health centers. Ann Intern Med 2003;138:143–149.Google Scholar
17. Gottesman, BS, Carmeli, Y, Shitrit, P, Chowers, M. Impact of quinolone restriction on resistance patterns of Escherichia coli isolated from urine by culture in a community setting. Clin Infect Dis 2009;49:869–875.CrossRefGoogle Scholar
18. Pena, C, Albareda, JM, Pallares, R, Pujol, M, Tubau, F, Ariza, J. Relationship between quinolone use and emergence of ciprofloxacin-resistant Escherichia coli in bloodstream infections. Antimicr Agents Chemother 1995;39:520–524.CrossRefGoogle ScholarPubMed
19. Gallini, A, Degris, E, Desplas, M, et al. Influence of fluoroquinolone consumption in inpatients and outpatients on ciprofloxacin-resistant Escherichia coli in a university hospital. J Antimicr Chemother 2010;65:2650–2657.Google Scholar
20. Lamikanra, A, Crowe, JL, Lijek, RS, et al. Rapid evolution of fluoroquinolone-resistant Escherichia coli in Nigeria is temporally associated with fluoroquinolone use. BMC Infect Dis 2011;11:312.Google Scholar
21. Wong-Beringer, A, Nguyen, LH, Lee, M, Shriner, KA, Pallares, J. An antimicrobial stewardship program with a focus on reducing fluoroquinolone overuse. Pharmacotherapy 2009;29:736–743.Google Scholar
22. Peterson, LR. Squeezing the antibiotic balloon: the impact of antimicrobial classes on emerging resistance. Clin Micro Infection 2005;11(Suppl 5):4–16.Google Scholar
23. Sandegren, L, Lindqvist, A, Kahlmeter, G, Andersson, DI. Nitrofurantoin resistance mechanism and fitness cost in Escherichia coli . J Antimicr Chemother 2008;62:495–503.CrossRefGoogle ScholarPubMed
24. Poulsen, HO, Johansson, A, Granholm, S, Kahlmeter, G, Sundqvist, M. High genetic diversity of nitrofurantoin- or mecillinam-resistant Escherichia coli indicates low propensity for clonal spread. J Antimicr Chemother 2013;68:1974–1977.Google Scholar
25. FDA announces final decision about veterinary medicine. US Food and Drug Administration website. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108467.htm. Published 2005. Accessed June 9, 2016.Google Scholar
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