Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context
Summary: Background: It is unclear whether changes in antimicrobial resistance (AMR) in primary care influence AMR in hospital settings. Therefore, we investigated the dynamic association of AMR between primary care and hospitals. Methods: We studied resistance percentages of Escherichia coli and K...
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2025-03-01
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| Series: | The Lancet Regional Health. Europe |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776224003661 |
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| author | Evelyn Pamela Martínez Annelies Verbon Annelot F. Schoffelen Wieke Altorf-van der Kuil Joost van Rosmalen James W.T. Cohen Stuart Damian C. Melles Karin van Dijk Ali Alzubaidy Maarten Scholing Sacha D. Kuil Gert J. Blaauw Wieke Altorf - van der Kuil Saskia M. Bierman Sabine C. de Greeff Sonja R. Groenendijk Rudy Hertroys Jos C.M. Monen Daan W. Notermans Jan Polman Wouter J. van den Reek Caroline Schneeberger-van der Linden Annelot F. Schoffelen Feline Velthuis Cornelia C.H. Wielders Britt J. de Wit Rony E. Zoetigheid Wouter van den Bijllaardt Elise M. Kraan Michiel B. Haeseker Júlia M. da Silva Eefje de Jong Boulos Maraha Arjanne J. van Griethuysen Bastiaan B. Wintermans Marijke J.C.A. van Trijp Anouk E. Muller Man-Chi Wong Alewijn Ott Erik Bathoorn Mariëtte Lokate Jan Sinnige Damian C. Melles Nienke Plantinga Nicole H.M. Renders Julia W. Dorigo-Zetsma Leendert J. Bakker Wim Ang Karola Waar Martha T. van der Beek Maurine A. Leversteijn-van Hall Suzan P. van Mens Erik Schaftenaar Marrigje H. Nabuurs-Franssen Ianthe Maat Patrick D.J. Sturm Bram M.W. Diederen Lonneke G.M. Bode David S.Y. Ong Michiel van Rijn Sander Dinant Martijn den Reijer Dick W. van Dam Els I.G.B. de Brauwer Robbert G. Bentvelsen Anton G.M. Buiting Anne L.M. Vlek Melanie de Graaf Annet Troelstra Arjan R. Jansz Maurits P.A. van Meer Janneke de Vries Julian D. Machiels |
| author_facet | Evelyn Pamela Martínez Annelies Verbon Annelot F. Schoffelen Wieke Altorf-van der Kuil Joost van Rosmalen James W.T. Cohen Stuart Damian C. Melles Karin van Dijk Ali Alzubaidy Maarten Scholing Sacha D. Kuil Gert J. Blaauw Wieke Altorf - van der Kuil Saskia M. Bierman Sabine C. de Greeff Sonja R. Groenendijk Rudy Hertroys Jos C.M. Monen Daan W. Notermans Jan Polman Wouter J. van den Reek Caroline Schneeberger-van der Linden Annelot F. Schoffelen Feline Velthuis Cornelia C.H. Wielders Britt J. de Wit Rony E. Zoetigheid Wouter van den Bijllaardt Elise M. Kraan Michiel B. Haeseker Júlia M. da Silva Eefje de Jong Boulos Maraha Arjanne J. van Griethuysen Bastiaan B. Wintermans Marijke J.C.A. van Trijp Anouk E. Muller Man-Chi Wong Alewijn Ott Erik Bathoorn Mariëtte Lokate Jan Sinnige Damian C. Melles Nienke Plantinga Nicole H.M. Renders Julia W. Dorigo-Zetsma Leendert J. Bakker Wim Ang Karola Waar Martha T. van der Beek Maurine A. Leversteijn-van Hall Suzan P. van Mens Erik Schaftenaar Marrigje H. Nabuurs-Franssen Ianthe Maat Patrick D.J. Sturm Bram M.W. Diederen Lonneke G.M. Bode David S.Y. Ong Michiel van Rijn Sander Dinant Martijn den Reijer Dick W. van Dam Els I.G.B. de Brauwer Robbert G. Bentvelsen Anton G.M. Buiting Anne L.M. Vlek Melanie de Graaf Annet Troelstra Arjan R. Jansz Maurits P.A. van Meer Janneke de Vries Julian D. Machiels |
| author_sort | Evelyn Pamela Martínez |
| collection | DOAJ |
| description | Summary: Background: It is unclear whether changes in antimicrobial resistance (AMR) in primary care influence AMR in hospital settings. Therefore, we investigated the dynamic association of AMR between primary care and hospitals. Methods: We studied resistance percentages of Escherichia coli and Klebsiella pneumoniae isolates to co-amoxiclav, ciprofloxacin, fosfomycin, nitrofurantoin and trimethoprim submitted by primary care, hospital outpatient and hospital inpatient settings to the Dutch National AMR surveillance network (ISIS-AR) from 2008 to 2020. For each bacterium–antibiotic combination, we first conducted multivariable logistic regressions to calculate AMR odds ratios (ORs) by month and healthcare setting, adjusted for patient-related factors and a time term. Second, multiple time series analysis was done using vector autoregressive models including the (log) ORs for each bacterium–antibiotic combination. Models were interpreted by impulse response functions and Granger-causality tests. Findings: The main AMR association was unidirectional from primary care to hospital settings with Granger-causality p-values between <0.0001 and 0.029. Depending on the bacterium–antibiotic combination, a 1% increase of AMR in E. coli and K. pneumoniae in primary care leads to an increase of AMR in hospital settings ranging from 0.10% to 0.40%. For ciprofloxacin resistance in K. pneumoniae, we found significant bidirectional associations between all healthcare settings with Granger-causality p-values between <0.0001 and 0.0075. Interpretation: For the majority of bacterium–antibiotic combinations, the main AMR association was from primary care to hospital settings. These results underscore the importance of antibiotic stewardship at the community level. Funding: ISIS-AR is supported by the Ministry of Health, Welfare and Sport of the Netherlands and the first author by the Central University of Ecuador to follow a PhD program in Erasmus MC. |
| format | Article |
| id | doaj-art-f07191146b2649a69e6a92fb20a3771c |
| institution | Kabale University |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-f07191146b2649a69e6a92fb20a3771c2025-01-04T04:57:14ZengElsevierThe Lancet Regional Health. Europe2666-77622025-03-0150101197Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in contextEvelyn Pamela Martínez0Annelies Verbon1Annelot F. Schoffelen2Wieke Altorf-van der Kuil3Joost van Rosmalen4James W.T. Cohen StuartDamian C. MellesKarin van DijkAli AlzubaidyMaarten ScholingSacha D. KuilGert J. BlaauwWieke Altorf - van der KuilSaskia M. BiermanSabine C. de GreeffSonja R. GroenendijkRudy HertroysJos C.M. MonenDaan W. NotermansJan PolmanWouter J. van den ReekCaroline Schneeberger-van der LindenAnnelot F. SchoffelenFeline VelthuisCornelia C.H. WieldersBritt J. de WitRony E. ZoetigheidWouter van den BijllaardtElise M. KraanMichiel B. HaesekerJúlia M. da SilvaEefje de JongBoulos MarahaArjanne J. van GriethuysenBastiaan B. WintermansMarijke J.C.A. van TrijpAnouk E. MullerMan-Chi WongAlewijn OttErik BathoornMariëtte LokateJan SinnigeDamian C. MellesNienke PlantingaNicole H.M. RendersJulia W. Dorigo-ZetsmaLeendert J. BakkerWim AngKarola WaarMartha T. van der BeekMaurine A. Leversteijn-van HallSuzan P. van MensErik SchaftenaarMarrigje H. Nabuurs-FranssenIanthe MaatPatrick D.J. SturmBram M.W. DiederenLonneke G.M. BodeDavid S.Y. OngMichiel van RijnSander DinantMartijn den ReijerDick W. van DamEls I.G.B. de BrauwerRobbert G. BentvelsenAnton G.M. BuitingAnne L.M. VlekMelanie de GraafAnnet TroelstraArjan R. JanszMaurits P.A. van MeerJanneke de VriesJulian D. MachielsFacultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador; Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Corresponding author. Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador.Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Infectious Diseases, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, the NetherlandsCentre for Infectious Diseases, Epidemiology and Surveillance, Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, the NetherlandsCentre for Infectious Diseases, Epidemiology and Surveillance, Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, the NetherlandsDepartment of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the NetherlandsSummary: Background: It is unclear whether changes in antimicrobial resistance (AMR) in primary care influence AMR in hospital settings. Therefore, we investigated the dynamic association of AMR between primary care and hospitals. Methods: We studied resistance percentages of Escherichia coli and Klebsiella pneumoniae isolates to co-amoxiclav, ciprofloxacin, fosfomycin, nitrofurantoin and trimethoprim submitted by primary care, hospital outpatient and hospital inpatient settings to the Dutch National AMR surveillance network (ISIS-AR) from 2008 to 2020. For each bacterium–antibiotic combination, we first conducted multivariable logistic regressions to calculate AMR odds ratios (ORs) by month and healthcare setting, adjusted for patient-related factors and a time term. Second, multiple time series analysis was done using vector autoregressive models including the (log) ORs for each bacterium–antibiotic combination. Models were interpreted by impulse response functions and Granger-causality tests. Findings: The main AMR association was unidirectional from primary care to hospital settings with Granger-causality p-values between <0.0001 and 0.029. Depending on the bacterium–antibiotic combination, a 1% increase of AMR in E. coli and K. pneumoniae in primary care leads to an increase of AMR in hospital settings ranging from 0.10% to 0.40%. For ciprofloxacin resistance in K. pneumoniae, we found significant bidirectional associations between all healthcare settings with Granger-causality p-values between <0.0001 and 0.0075. Interpretation: For the majority of bacterium–antibiotic combinations, the main AMR association was from primary care to hospital settings. These results underscore the importance of antibiotic stewardship at the community level. Funding: ISIS-AR is supported by the Ministry of Health, Welfare and Sport of the Netherlands and the first author by the Central University of Ecuador to follow a PhD program in Erasmus MC.http://www.sciencedirect.com/science/article/pii/S2666776224003661Antimicrobial resistanceGeneral practitionersHealth care settingsGranger causalityMultiple time series |
| spellingShingle | Evelyn Pamela Martínez Annelies Verbon Annelot F. Schoffelen Wieke Altorf-van der Kuil Joost van Rosmalen James W.T. Cohen Stuart Damian C. Melles Karin van Dijk Ali Alzubaidy Maarten Scholing Sacha D. Kuil Gert J. Blaauw Wieke Altorf - van der Kuil Saskia M. Bierman Sabine C. de Greeff Sonja R. Groenendijk Rudy Hertroys Jos C.M. Monen Daan W. Notermans Jan Polman Wouter J. van den Reek Caroline Schneeberger-van der Linden Annelot F. Schoffelen Feline Velthuis Cornelia C.H. Wielders Britt J. de Wit Rony E. Zoetigheid Wouter van den Bijllaardt Elise M. Kraan Michiel B. Haeseker Júlia M. da Silva Eefje de Jong Boulos Maraha Arjanne J. van Griethuysen Bastiaan B. Wintermans Marijke J.C.A. van Trijp Anouk E. Muller Man-Chi Wong Alewijn Ott Erik Bathoorn Mariëtte Lokate Jan Sinnige Damian C. Melles Nienke Plantinga Nicole H.M. Renders Julia W. Dorigo-Zetsma Leendert J. Bakker Wim Ang Karola Waar Martha T. van der Beek Maurine A. Leversteijn-van Hall Suzan P. van Mens Erik Schaftenaar Marrigje H. Nabuurs-Franssen Ianthe Maat Patrick D.J. Sturm Bram M.W. Diederen Lonneke G.M. Bode David S.Y. Ong Michiel van Rijn Sander Dinant Martijn den Reijer Dick W. van Dam Els I.G.B. de Brauwer Robbert G. Bentvelsen Anton G.M. Buiting Anne L.M. Vlek Melanie de Graaf Annet Troelstra Arjan R. Jansz Maurits P.A. van Meer Janneke de Vries Julian D. Machiels Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context The Lancet Regional Health. Europe Antimicrobial resistance General practitioners Health care settings Granger causality Multiple time series |
| title | Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context |
| title_full | Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context |
| title_fullStr | Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context |
| title_full_unstemmed | Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context |
| title_short | Dynamic association of antimicrobial resistance in urinary isolates of Escherichia coli and Klebsiella pneumoniae between primary care and hospital settings in the Netherlands (2008–2020): a population-based studyResearch in context |
| title_sort | dynamic association of antimicrobial resistance in urinary isolates of escherichia coli and klebsiella pneumoniae between primary care and hospital settings in the netherlands 2008 2020 a population based studyresearch in context |
| topic | Antimicrobial resistance General practitioners Health care settings Granger causality Multiple time series |
| url | http://www.sciencedirect.com/science/article/pii/S2666776224003661 |
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dynamicassociationofantimicrobialresistanceinurinaryisolatesofescherichiacoliandklebsiellapneumoniaebetweenprimarycareandhospitalsettingsinthenetherlands20082020apopulationbasedstudyresearchincontext AT arjanrjansz dynamicassociationofantimicrobialresistanceinurinaryisolatesofescherichiacoliandklebsiellapneumoniaebetweenprimarycareandhospitalsettingsinthenetherlands20082020apopulationbasedstudyresearchincontext AT mauritspavanmeer dynamicassociationofantimicrobialresistanceinurinaryisolatesofescherichiacoliandklebsiellapneumoniaebetweenprimarycareandhospitalsettingsinthenetherlands20082020apopulationbasedstudyresearchincontext AT jannekedevries dynamicassociationofantimicrobialresistanceinurinaryisolatesofescherichiacoliandklebsiellapneumoniaebetweenprimarycareandhospitalsettingsinthenetherlands20082020apopulationbasedstudyresearchincontext AT juliandmachiels dynamicassociationofantimicrobialresistanceinurinaryisolatesofescherichiacoliandklebsiellapneumoniaebetweenprimarycareandhospitalsettingsinthenetherlands20082020apopulationbasedstudyresearchincontext |