Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

Muller, Allison; Bertrand, Xavier; Rogues, Anne-Marie; Péfau, Muriel; Alfandari, Serge; Gauzit, Rémy; Dumartin, Catherine; Gbaguidi-Haore, Houssein

doi:10.1186/s13756-018-0302-8

Antimicrobial Resistance & Infection Control

Table 3 Factors associated with the reduction in carbapenem use from random-effects logistic regression model

From: Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

Variable	Univariable analysis		Multivariable analysis
Variable	OR	p	OR	p^a	95% CI
Type of ward (reference: Medical)
ICU	0.94	0.83	*0.07*	*0.005*	*0.01–0.46*
Surgical	0.95	0.81	0.66	0.19	0.35–1.23
Ward size in 2013, per increase of 50 beds	0.90	0.14	*0.79*	*0.02*	*0.64–0.97*
Type of HCF (reference: General hospital)
University hospital	0.42	0.35	0.28	0.25	0.03–2.39
Private hospital	1.06	0.85	0.66	0.28	0.31–1.40
Cancer centre	0.37	0.29	*0.09*	*0.04*	*0.01–0.88*
Local hospital	2.33	0.18	1.19	0.83	0.25–5.54
Rehabilitation and long-term care facility	0.38	0.50	0.24	0.40	0.01–6.59
Military hospital	0.43	0.34	0.18	0.09	0.02–1.28
Geographical area (reference: South-east)
North	1.42	0.42	2.33	0.09	0.88–6.16
West	1.15	0.80	1.09	0.90	0.30–3.94
East	1.93	0.15	*3.11*	*0.03*	*1.10–8.77*
South-west	1.78	0.17	1.57	0.36	0.60–4.12
Antibiotic use, DDDs per 1000 patients-days
Initial CBP use^b	1.01	0.01	0.97	0.08	0.95–1.00
Initial prescribing profile of CBPs^c	1.22	0.002	*3.16*	*< 0.001*	*1.88–5.34*
Initial 3GC use^b	1.00	0.79
Initial prescribing profile of 3GCs^c	0.97	0.16	*0.89*	*0.002*	*0.83–0.96*
Reduction in 3GC use^d	1.34	0.23
Initial FQ use^b	1.00	0.25
Initial prescribing profile of FQs^c	1.02	0.29
Reduction in FQ use^d	2.21	0.004	*2.3*	*0.02*	*1.17–4.53*
Initial AG use^b	1.00	0.50
Initial prescribing profile of AGs^c	0.97	0.44
Reduction in AG use^d	1.56	0.06	1.13	0.67	0.65–1.96
Initial AP ± BLI use^b	1.00	0.83
Initial prescribing profile of AP±BLIs^c	1.00	0.99
Reduction in AP ± BLI use^d	1.10	0.68
Initial Imidazole use^b	1.00	0.98
Initial prescribing profile of imidazoles^c	0.97	0.45
Reduction in imidazole use^d	1.65	0.03	1.50	0.15	0.87–2.59
Initial GP use^b	1.00	0.95
Initial prescribing profile of GPs^c	0.97	0.61
Reduction in GP use^d	1.83	0.01	*1.98*	*0.02*	*1.13–3.45*
Initial TZP use^b	1.00	0.99
Initial prescribing profile of TZP^c	0.95	0.33
Reduction in TZP use^d	4.24	< 0.001	*4.02*	*< 0.001*	*1.99–8.14*
Initial use of other alternatives to CBPs^b	1.00	0.88
Initial prescribing profile of other alternatives to CBPs^c	1.31	0.25
Reduction in the use of other alternatives to CBPs^d	1.07	0.79
Initial overall antibiotic use^b	1.00	0.72	1.00	0.97	0.99–1.01
Reduction in the overall antibiotic use^d	2.02	0.003	1.38	0.29	0.76–2.51
Region with high ESBL-PE incidence rate in acute care settings^e	0.65	0.12	*0.40*	*0.01*	*0.19–0.82*

OR odds ratio, CI confidence interval, ICU intensive care unit, HCF healthcare facility, DDD defined daily dose, CBP carbapenem, 3GC third-generation cephalosporin, FQ fluoroquinolone, AG aminoglycoside, AP ± BLI aminopenicillin ± β-lactamase inhibitor, GP glycopeptide, TZP piperacillin/tazobactam. ESBL-PE extended-spectrum β-lactamase-producing Enterobacteriaceae
^aSignificant associations (p < 0.05) from multivariable analysis are highlighted in bold italic
^bConsumption of a given antibiotic in 2009
^cProportion (%) of a given antibiotic in the total antibiotic consumption in 2009
^dReduction in the consumption of a given antibiotic between 2009 and 2013
^eData from the French multidrug-resistant bacteria surveillance network; BMR-RAISIN, 2011

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