Association of key patient characteristics with exposure to pCA antibiotics (group comparisons using Χ² testing).

<p>Association of key patient characteristics with exposure to pCA antibiotics (group comparisons using Χ² testing).</p

Calibration plot for logistic regression risk model of pCA exposure.

<p>Calibration plot for logistic regression risk model of pCA exposure.</p

Crude and risk adjusted regional exposure rates for pediatric reserve antibiotics.

<p>Bars correspond to crude rates, squares to adjusted rates (shown with 95% confidence intervals). Data for Eastern Europe have been omitted due to low number of patients surveyed (n = 17) The horizontal line indicates the mean pCA exposure rate in the whole cohort. Patient numbers for each region are shown at the bottom of each bar.</p

Distribution of included patients for 6 predefined groups by region.

<p>Distribution of included patients for 6 predefined groups by region.</p

Calibration plot for logistic regression classification model of pCA exposure.

<p>Calibration plot for logistic regression classification model of pCA exposure.</p

Overall proportions of treated patients within predefined group and the expected rate of exposure to pediatric reserve antibiotics (pCAs).

<p>Overall proportions of treated patients within predefined group and the expected rate of exposure to pediatric reserve antibiotics (pCAs).</p

Flow chart of prescription and patient inclusion.

<p>Flow chart of prescription and patient inclusion.</p

Logistic regression results showing adjusted odds ratios for exposure to pediatric reserve antibiotics (pCAs) with 95% confidence intervals.

<p>Logistic regression results showing adjusted odds ratios for exposure to pediatric reserve antibiotics (pCAs) with 95% confidence intervals.</p

Antibiotic Exposure and Other Risk Factors for Antimicrobial Resistance in Nasal Commensal <i>Staphylococcus aureus</i>: An Ecological Study in 8 European Countries

<div><p>Objectives</p><p>Antimicrobial resistance (AMR) has become a global public health concern which threatens the effective treatment of bacterial infections. Resistant <i>Staphylococcus aureus</i> (including MRSA) increasingly appears in individuals with no healthcare associated risks. Our study assessed risk factors for nasal carriage of resistant <i>S</i>. <i>aureus</i> in a multinational, healthy, community-based population, including ecological exposure to antibiotics.</p><p>Methods</p><p>Data were collected in eight European countries (Austria, Belgium, Croatia, France, Hungary, the Netherlands, Spain and Sweden). Commensal AMR patterns were assessed by collecting 28,929 nasal swabs from healthy persons (aged 4+). Ecological exposure to antibiotics was operationalized as systemic antibiotic treatment patterns, extracted from electronic medical records of primary care practices in which the participants were listed (10–27 per country). A multilevel analysis related AMR in nasal commensal <i>S</i>. <i>aureus</i> to antibiotic exposure and other risk factors (e.g. age and profession).</p><p>Results</p><p>Of the 6,093 <i>S</i>. <i>aureus</i> isolates, 77% showed resistance to at least one antibiotic. 7.1% exhibited multidrug resistance (defined as resistance to 3 or more antibiotic classes), and we found 78 cases MRSA (1.3%). A large variation in antibiotic exposure was found between and within countries. Younger age and a higher proportion of penicillin prescriptions in a practice were associated with higher odds for carriage of a resistant <i>S</i>. <i>aureus</i>. Also, we found higher multidrug resistance rates in participants working in healthcare or nurseries.</p><p>Conclusions</p><p>This study indicates that in a population with no recent antibiotic use, the prescription behavior of the general practitioner affects the odds for carriage of a resistant <i>S</i>. <i>aureus</i>, highlighting the need for cautious prescribing in primary care. Finally, since variation in AMR could partly be explained on a national level, policy initiatives to decrease AMR should be encouraged at the national level within Europe.</p></div

Independent risk factors for antibiotic resistance and for multidrug resistance (N = 5,191 <i>S</i>. <i>aureus</i> isolates).

<p>*significant p<0.05</p><p>Independent risk factors for antibiotic resistance and for multidrug resistance (N = 5,191 <i>S</i>. <i>aureus</i> isolates).</p