JAC Advance Access published online on February 25, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg146
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Center for Health Equity
Research and Promotion, Philadelphia Veterans Affairs Medical Center;
Departments of
Medicine and Biostatistics and Epidemiology, the Center for Clinical
Epidemiology and Biostatistics, the Center for Education and Research
on Therapeutics, and the Leonard Davis Institute of Health Economics, University
of Pennsylvania, Philadelphia, PA, USA
* Corresponding author. E-mail: jmetlay{at}cceb.med.upenn.edu.
Received 11 October 2001
; revised 21 May 2002
; accepted 27 December 2002
Objectives: Antimicrobial drug use
is believed to be an important risk factor for the emerging problem
of antimicrobial drug resistance, yet strong evidence for the causal
relationship in community settings has been limited. Detailed analysis
of this risk factor at the level of the individual patient has been
hampered by limited availability of drug exposure data among patients
with outpatient infections. We used a novel data system to identify
patterns of individual antimicrobial drug exposures associated with
trimethoprim-sulfamethoxazole-resistant urinary tract infections
(UTIs). Materials and methods: This was a retrospective
case-control study. Subjects were veterans with Gram-negative
UTIs seen at the Philadelphia VA Medical Center from 1 July 1996
to 31 December 1999. Subjects were linked to a national VA outpatient
pharmacy database. Cases and controls were identified based on the
results of trimethoprim-sulfamethoxazole susceptibility
testing. Results: Three hundred and ninety-three veterans
with UTIs could be linked to electronic pharmacy records. The overall
rate of trimethoprim-sulfamethoxazole drug resistance was 13%,
without significant annual variation. Antimicrobial drug exposure
within 6 months was strongly associated with the probability of
a trimethoprim-sulfamethoxazole-resistant infection (OR = 4.1,
95% CI 2.2-7.5). This association extended to
exposure to other antimicrobial drugs in addition to trimethoprim-sulfamethoxazole
and the overall association displayed a dose-response relationship
in terms of the number of prior drug exposures. Conclusions: Prior antimicrobial drug exposure
is a strong risk factor for infection with trimethoprim-sulfamethoxazole-resistant
Gram-negative bacteria among patients with UTIs.
Prior antimicrobial drug exposure: a risk factor
for trimethoprim-sulfamethoxazole-resistant urinary tract
infections
2 Departments of
Medicine and Biostatistics and Epidemiology, the Center for Clinical
Epidemiology and Biostatistics, the Center for Education and Research
on Therapeutics, and the Leonard Davis Institute of Health Economics, University
of Pennsylvania, Philadelphia, PA, USA
3 Center for Health Equity
Research and Promotion, Philadelphia Veterans Affairs Medical Center;
; Departments of
Medicine and Biostatistics and Epidemiology, the Center for Clinical
Epidemiology and Biostatistics, the Center for Education and Research
on Therapeutics, and the Leonard Davis Institute of Health Economics, University
of Pennsylvania, Philadelphia, PA, USA
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