TY  - JOUR
A1  - Kurotschka, Peter Konstantin
A1  - Fulgenzio, Chiara
A1  - Da Cas, Roberto
A1  - Traversa, Giuseppe
A1  - Ferrante, Gianluigi
A1  - Massidda, Orietta
A1  - Gágyor, Ildikó
A1  - Aschbacher, Richard
A1  - Moser, Verena
A1  - Pagani, Elisabetta
A1  - Spila Alegiani, Stefania
A1  - Massari, Marco
T1  - Effect of fluoroquinolone use in primary care on the development and gradual decay of Escherichia coli resistance to fluoroquinolones: a matched case-control study
JF  - Antibiotics
N2  - The reversibility of bacterial resistance to antibiotics is poorly understood. Therefore, the aim of this study was to determine, over a period of five years, the effect of fluoroquinolone (FQ) use in primary care on the development and gradual decay of Escherichia coli resistance to FQ. In this matched case–control study, we linked three sources of secondary data of the Health Service of the Autonomous Province of Bolzano, Italy. Cases were all those with an FQ-resistant E. coli (QREC)-positive culture from any site during a 2016 hospital stay. Data were analyzed using conditional logistic regression. A total of 409 cases were matched to 993 controls (FQ-sensitive E. coli) by the date of the first isolate. Patients taking one or more courses of FQ were at higher risk of QREC colonization/infection. The risk was highest during the first year after FQ was taken (OR 2.67, 95%CI 1.92–3.70, p < 0.0001), decreased during the second year (OR 1.54, 95%CI 1.09–2.17, p = 0.015) and became undetectable afterwards (OR 1.09, 95%CI 0.80–1.48, p = 0.997). In the first year, the risk of resistance was highest after greater cumulative exposure to FQs. Moreover, older age, male sex, longer hospital stays, chronic obstructive pulmonary disease (COPD) and diabetes mellitus were independent risk factors for QREC colonization/infection. A single FQ course significantly increases the risk of QREC colonization/infection for no less than two years. This risk is higher in cases of multiple courses, longer hospital stays, COPD and diabetes; in males; and in older patients. These findings may inform public campaigns and courses directed to prescribers to promote rational antibiotic use.
KW  - drug resistance
KW  - bacterial
KW  - antimicrobial resistance
KW  - anti-bacterial agents
KW  - primary care
KW  - quinolones
KW  - fluoroquinolones
KW  - information storage and retrieval
KW  - Escherichia coli
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-278771
SN  - 2079-6382
VL  - 11
IS  - 6
ER  - 
TY  - JOUR
A1  - Kurotschka, Peter Konstantin
A1  - Tiedemann, Elena
A1  - Wolf, Dominik
A1  - Thier, Nicola
A1  - Forster, Johannes
A1  - Liese, Johannes G.
A1  - Gagyor, Ildiko
T1  - Management of common infections in German primary care: a cross-sectional survey of knowledge and confidence among General Practitioners and outpatient pediatricians
JF  - Antibiotics
N2  - Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners' (GPs) and outpatient pediatricians' (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients' demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.
KW  - infectious diseases management
KW  - general practitioner
KW  - pediatrician
KW  - primary care
KW  - outpatient
KW  - antibiotic use
KW  - antimicrobial resistance
KW  - antimicrobial stewardship
KW  - survey
KW  - knowledge
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246272
SN  - 2079-6382
VL  - 10
IS  - 9
ER  -