Trimethoprim prescription and subsequent resistance in childhood urinary infection

multilevel modelling analysis

Mary A Duffy, Virginia Hernandez-Santiago, Gillian Orange, Peter G Davey, Bruce Guthrie

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    Background:
    Antibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children.

    Aim:
    To investigate the association between previous trimethoprim prescribing and resistance in urinary Escherichia coli (E. coli) isolates in children.

    Design and setting:
    Retrospective, population cohort study in Tayside, Scotland.

    Method:
    Multilevel modelling of linked microbiology and dispensed prescribing data for 1373 =16-year-olds with E. coli urinary isolates in 2004-2009, examining the association between prior trimethoprim prescription and subsequent trimethoprim resistance in people with urinary E. coli isolates.

    Results:
    Trimethoprim resistance was common (26.6%, 95% confidence interval [CI] = 24.6 to 28.6). Previous trimethoprim prescription was associated with subsequent culture of trimethoprim-resistant E. coli, with more recent prescription being more strongly associated with resistance. After adjusting for the number of previous E. coli isolates and sample year, trimethoprim prescribing in the previous 84 days remained significantly associated with culturing trimethoprim-resistant E. coli (adjusted OR 4.71, 95% CI = 1.83 to 12.16 for the previous 15-28 days versus never prescribed; adjusted OR 3.16, 95% CI = 1.63 to 6.13 for the previous 29-84 days); however, associations were not statistically significant for longer periods since prior exposure.

    Conclusion:
    Trimethoprim prescription has implications for future resistance in individual children, as well as at population level. Clinicians must ensure appropriateness of treatment choice and duration, and alternative antibiotics should be considered for childhood urinary tract infections if trimethoprim has been prescribed in the preceding 3 months.
    Original languageEnglish
    Pages (from-to)238-43
    Number of pages6
    JournalBritish Journal of General Practice
    Volume63
    Issue number609
    DOIs
    Publication statusPublished - Apr 2013

    Fingerprint

    Multilevel Analysis
    Trimethoprim
    Prescriptions
    Trimethoprim Resistance
    Escherichia coli
    Infection
    Confidence Intervals
    Microbial Drug Resistance
    Anti-Bacterial Agents
    Scotland
    Microbiology
    Urinary Tract Infections
    Population
    Cohort Studies

    Cite this

    @article{24d1fcef332b44f7bed9206b6df91fb1,
    title = "Trimethoprim prescription and subsequent resistance in childhood urinary infection: multilevel modelling analysis",
    abstract = "Background:Antibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children.Aim:To investigate the association between previous trimethoprim prescribing and resistance in urinary Escherichia coli (E. coli) isolates in children.Design and setting:Retrospective, population cohort study in Tayside, Scotland.Method:Multilevel modelling of linked microbiology and dispensed prescribing data for 1373 =16-year-olds with E. coli urinary isolates in 2004-2009, examining the association between prior trimethoprim prescription and subsequent trimethoprim resistance in people with urinary E. coli isolates.Results:Trimethoprim resistance was common (26.6{\%}, 95{\%} confidence interval [CI] = 24.6 to 28.6). Previous trimethoprim prescription was associated with subsequent culture of trimethoprim-resistant E. coli, with more recent prescription being more strongly associated with resistance. After adjusting for the number of previous E. coli isolates and sample year, trimethoprim prescribing in the previous 84 days remained significantly associated with culturing trimethoprim-resistant E. coli (adjusted OR 4.71, 95{\%} CI = 1.83 to 12.16 for the previous 15-28 days versus never prescribed; adjusted OR 3.16, 95{\%} CI = 1.63 to 6.13 for the previous 29-84 days); however, associations were not statistically significant for longer periods since prior exposure.Conclusion:Trimethoprim prescription has implications for future resistance in individual children, as well as at population level. Clinicians must ensure appropriateness of treatment choice and duration, and alternative antibiotics should be considered for childhood urinary tract infections if trimethoprim has been prescribed in the preceding 3 months.",
    author = "Duffy, {Mary A} and Virginia Hernandez-Santiago and Gillian Orange and Davey, {Peter G} and Bruce Guthrie",
    year = "2013",
    month = "4",
    doi = "10.3399/bjgp13X665198",
    language = "English",
    volume = "63",
    pages = "238--43",
    journal = "British Journal of General Practice",
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    }

    Trimethoprim prescription and subsequent resistance in childhood urinary infection : multilevel modelling analysis. / Duffy, Mary A; Hernandez-Santiago, Virginia; Orange, Gillian; Davey, Peter G; Guthrie, Bruce.

    In: British Journal of General Practice, Vol. 63, No. 609, 04.2013, p. 238-43.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Trimethoprim prescription and subsequent resistance in childhood urinary infection

    T2 - multilevel modelling analysis

    AU - Duffy, Mary A

    AU - Hernandez-Santiago, Virginia

    AU - Orange, Gillian

    AU - Davey, Peter G

    AU - Guthrie, Bruce

    PY - 2013/4

    Y1 - 2013/4

    N2 - Background:Antibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children.Aim:To investigate the association between previous trimethoprim prescribing and resistance in urinary Escherichia coli (E. coli) isolates in children.Design and setting:Retrospective, population cohort study in Tayside, Scotland.Method:Multilevel modelling of linked microbiology and dispensed prescribing data for 1373 =16-year-olds with E. coli urinary isolates in 2004-2009, examining the association between prior trimethoprim prescription and subsequent trimethoprim resistance in people with urinary E. coli isolates.Results:Trimethoprim resistance was common (26.6%, 95% confidence interval [CI] = 24.6 to 28.6). Previous trimethoprim prescription was associated with subsequent culture of trimethoprim-resistant E. coli, with more recent prescription being more strongly associated with resistance. After adjusting for the number of previous E. coli isolates and sample year, trimethoprim prescribing in the previous 84 days remained significantly associated with culturing trimethoprim-resistant E. coli (adjusted OR 4.71, 95% CI = 1.83 to 12.16 for the previous 15-28 days versus never prescribed; adjusted OR 3.16, 95% CI = 1.63 to 6.13 for the previous 29-84 days); however, associations were not statistically significant for longer periods since prior exposure.Conclusion:Trimethoprim prescription has implications for future resistance in individual children, as well as at population level. Clinicians must ensure appropriateness of treatment choice and duration, and alternative antibiotics should be considered for childhood urinary tract infections if trimethoprim has been prescribed in the preceding 3 months.

    AB - Background:Antibiotic resistance is a growing concern and antibiotic usage the main contributing factor, but there are few studies examining antibiotic use and resistance in children.Aim:To investigate the association between previous trimethoprim prescribing and resistance in urinary Escherichia coli (E. coli) isolates in children.Design and setting:Retrospective, population cohort study in Tayside, Scotland.Method:Multilevel modelling of linked microbiology and dispensed prescribing data for 1373 =16-year-olds with E. coli urinary isolates in 2004-2009, examining the association between prior trimethoprim prescription and subsequent trimethoprim resistance in people with urinary E. coli isolates.Results:Trimethoprim resistance was common (26.6%, 95% confidence interval [CI] = 24.6 to 28.6). Previous trimethoprim prescription was associated with subsequent culture of trimethoprim-resistant E. coli, with more recent prescription being more strongly associated with resistance. After adjusting for the number of previous E. coli isolates and sample year, trimethoprim prescribing in the previous 84 days remained significantly associated with culturing trimethoprim-resistant E. coli (adjusted OR 4.71, 95% CI = 1.83 to 12.16 for the previous 15-28 days versus never prescribed; adjusted OR 3.16, 95% CI = 1.63 to 6.13 for the previous 29-84 days); however, associations were not statistically significant for longer periods since prior exposure.Conclusion:Trimethoprim prescription has implications for future resistance in individual children, as well as at population level. Clinicians must ensure appropriateness of treatment choice and duration, and alternative antibiotics should be considered for childhood urinary tract infections if trimethoprim has been prescribed in the preceding 3 months.

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    DO - 10.3399/bjgp13X665198

    M3 - Article

    VL - 63

    SP - 238

    EP - 243

    JO - British Journal of General Practice

    JF - British Journal of General Practice

    SN - 0960-1643

    IS - 609

    ER -