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Seasonality of Antibiotic Resistance and Correlation with Antibiotic Use

Seasonality of Antibiotic Resistance and Correlation with Antibiotic Use. Lova Sun CDDEP Summer 2010. Questions. Is antibiotic resistance of different bacteria seasonal? (E coli, MRSA , VRE) TSN Database

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Seasonality of Antibiotic Resistance and Correlation with Antibiotic Use

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  1. Seasonality of Antibiotic Resistance and Correlation with Antibiotic Use Lova Sun CDDEP Summer 2010

  2. Questions • Is antibiotic resistance of different bacteria seasonal? (E coli, MRSA, VRE) • TSN Database • Do prescription levels of antibiotics which might be driving this resistance also show seasonal trends? • IMS Database • Is antibiotic prescription seasonality temporally correlated to seasonality of resistant bugs, perhaps with time lag? • Cross-correlation analysis, time-series regressions, Granger causality

  3. Part I: E. coliIs E. Coli Antibiotic Resistance Seasonal? Resistance to Ampicillin: Winter Peak Resistance to Ciprofloxacin: Winter Peak

  4. Are Prescriptions of these Antibiotics Seasonal? Aminopenicillin Prescriptions: Winter Peak Fluoroquinolone Prescriptions: Winter Peak

  5. Prescription-Resistance Correlations: Detrended Data Ampicillin (1-month lag Correlation = 0.7816) Ciprofloxacin (Unlagged Correlation = 0.4310)

  6. Part II: MRSAIs MRSA a seasonal bug? Not Combined. But…

  7. HA- and CA-MRSA Seasonality HA-MRSA: Winter Peak CA-MRSA: Summer Peak TSN Data NHDS Data

  8. Possible Antibiotic Drivers of HA-MRSA Prescription Seasonality: Winter Peaks Correlation: Prescriptions and HA-MRSA Quinolones: 2-month lag (Correlation 0.5810) Macrolides: 1-month lag (Correlation 0.6699) Cephalosporins: 1-month lag (Correlation 0.6713)

  9. Possible Antibiotic Driver of CA-MRSA Staph Penicillin Prescriptions: Summer Peak 1-month lag (Correlation 0.6371)

  10. Part III: Vancomycin-Resistant EnterococciVRE Seasonality and Correlation with HA-MRSA Vancomycin Resistance: Winter Peak VRE and HA-MRSA: Correlation = 0.6431 No time lag

  11. Conclusions • Both antibiotic resistance and prescriptions are seasonal • After a 1-2 month lag (presumably the time it takes for antibiotic use to select for resistant strains), antibiotic prescriptions are significantly correlated with (and perhaps drive) resistance • CA- and HA-MRSA have opposite seasonal peaks, with different antibiotics or other factors driving each type • MRSA, an indicator of vancomycin use, is correlated with VRE • Implications for hospital infection control and prescription policies

  12. Acknowledgements • Prof. RamananLaxminarayan • Prof. Bryan Grenfell • Eili Klein • Mike Eber

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