Estimating the impact of cefuroxime versus cefazolin and amoxicillin/clavulanate use on future collateral resistance: a retrospective comparison. (15th April 2022)

• Record Type: Journal Article
• Authors: Chowers, Michal; Zehavi, Tamir; Gottesman, Bat Sheva; Baraz, Avi; Nevo, Daniel; Obolski, Uri
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 77:Number 7(2022)
• Page Start: 1992
• Page End: 1995
• Publication Date: 2022-04-15
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkac130
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Background: Quantitative estimates of collateral resistance induced by antibiotic use are scarce. Objectives: To estimate the effects of treatment with amoxicillin/clavulanate or cefazolin, compared with cefuroxime, on future resistance to ceftazidime among hospitalized patients. Methods: A retrospective analysis of patients with positive bacterial cultures hospitalized in an Israeli hospital during 2016–19 was conducted. Patients were restricted to those treated with amoxicillin/clavulanate, cefazolin or cefuroxime and re-hospitalized with a positive bacterial culture during the following year. Matching was performed using exact, Mahalanobis and propensity score matching. Each patient in the amoxicillin/clavulanate and cefazolin groups was matched to a single patient from the cefuroxime group, yielding 185:185 and 298:298 matched patients. Logistic regression and the g-formula (standardization) were used to estimate the OR, risk difference (RD) and number needed to harm (NNH). Results: Cefuroxime induced significantly higher resistance to ceftazidime than amoxicillin/clavulanate or cefazolin; the marginal OR was 1.76 (95% CI = 1.16–2.83) compared with amoxicillin/clavulanate and 1.98 (95% CI = 1.41–2.8) compared with cefazolin and the RD was 0.118 (95% CI = 0.031–0.215) compared with amoxicillin/clavulanate and 0.131 (95% CI = 0.058–0.197) compared with cefazolin. We also estimated the NNH; replacing amoxicillin/clavulanate or cefazolin with cefuroxime would yield ceftazidime resistance in 1 more patient for every 8.5 (95% CI = 4.66–32.14) or 7.6 (95% CI = 5.1–17.3) patients re-hospitalized in the following year, respectively. Conclusions: Our results indicate that treatment with amoxicillin/clavulanate or cefazolin is preferable to cefuroxime, in terms of future collateral resistance. The results presented here are a first step towards quantitative estimations of the ecological damage caused by different antibiotics.