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Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia
Surveillance of antimicrobial resistance (AMR) enables monitoring of trends in AMR prevalence. WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias...
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Published in: | PloS one 2020-03, Vol.15 (3), p.e0230489-e0230489 |
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description | Surveillance of antimicrobial resistance (AMR) enables monitoring of trends in AMR prevalence. WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory- and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/- 5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and meropenem. Laboratory-based AMR surveillance of uropathogens, is not adequate to guide empirical treatment for community-based settings in Indonesia. |
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WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory- and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/- 5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and meropenem. Laboratory-based AMR surveillance of uropathogens, is not adequate to guide empirical treatment for community-based settings in Indonesia.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0230489</identifier><identifier>PMID: 32226038</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Ambulatory care facilities ; Amikacin ; Analysis ; Antibacterial agents ; Antibiotics ; Antimicrobial agents ; Antimicrobial resistance ; Bias ; Biology and Life Sciences ; Care and treatment ; Ceftriaxone ; Confidence intervals ; Drug resistance ; E coli ; Escherichia coli ; Gynecology ; Health aspects ; Hospitals ; Internal medicine ; Klebsiella ; Klebsiella pneumoniae ; Laboratories ; Malik, Adam ; Medicine ; Medicine and Health Sciences ; Meropenem ; Microbial drug resistance ; Microbiology ; Obstetrics ; Patients ; Piperacillin ; Piperacillin-tazobactam ; Pneumonia ; Population ; Prejudice ; Research and Analysis Methods ; Setting (Literature) ; Studies ; Surveillance ; Surveillance systems ; Tazobactam ; Trends ; Urinary tract ; Urinary tract diseases ; Urinary tract infections ; Urine ; Urogenital system</subject><ispartof>PloS one, 2020-03, Vol.15 (3), p.e0230489-e0230489</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Sugianli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory- and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/- 5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and meropenem. Laboratory-based AMR surveillance of uropathogens, is not adequate to guide empirical treatment for community-based settings in Indonesia.</description><subject>Ambulatory care facilities</subject><subject>Amikacin</subject><subject>Analysis</subject><subject>Antibacterial agents</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Ceftriaxone</subject><subject>Confidence intervals</subject><subject>Drug resistance</subject><subject>E coli</subject><subject>Escherichia coli</subject><subject>Gynecology</subject><subject>Health aspects</subject><subject>Hospitals</subject><subject>Internal medicine</subject><subject>Klebsiella</subject><subject>Klebsiella pneumoniae</subject><subject>Laboratories</subject><subject>Malik, Adam</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Meropenem</subject><subject>Microbial drug resistance</subject><subject>Microbiology</subject><subject>Obstetrics</subject><subject>Patients</subject><subject>Piperacillin</subject><subject>Piperacillin-tazobactam</subject><subject>Pneumonia</subject><subject>Population</subject><subject>Prejudice</subject><subject>Research and Analysis Methods</subject><subject>Setting (Literature)</subject><subject>Studies</subject><subject>Surveillance</subject><subject>Surveillance systems</subject><subject>Tazobactam</subject><subject>Trends</subject><subject>Urinary tract</subject><subject>Urinary tract diseases</subject><subject>Urinary tract infections</subject><subject>Urine</subject><subject>Urogenital 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versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia</title><author>Sugianli, Adhi Kristianto ; Ginting, Franciscus ; Kusumawati, R Lia ; Parwati, Ida ; de Jong, Menno D ; van Leth, Frank ; Schultsz, Constance</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-aa7598253af74bf79d4053a72f6efd9f574ed0ea5e7e41ce42fc5176e3d8f7e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Ambulatory care facilities</topic><topic>Amikacin</topic><topic>Analysis</topic><topic>Antibacterial agents</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Antimicrobial resistance</topic><topic>Bias</topic><topic>Biology and Life Sciences</topic><topic>Care and treatment</topic><topic>Ceftriaxone</topic><topic>Confidence intervals</topic><topic>Drug resistance</topic><topic>E 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exist.</notes><abstract>Surveillance of antimicrobial resistance (AMR) enables monitoring of trends in AMR prevalence. WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory- and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/- 5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and meropenem. Laboratory-based AMR surveillance of uropathogens, is not adequate to guide empirical treatment for community-based settings in Indonesia.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32226038</pmid><doi>10.1371/journal.pone.0230489</doi><tpages>e0230489</tpages><orcidid>https://orcid.org/0000-0002-2898-6719</orcidid><orcidid>https://orcid.org/0000-0002-5490-8968</orcidid><orcidid>https://orcid.org/0000-0003-2280-7844</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1932-6203 |
ispartof | PloS one, 2020-03, Vol.15 (3), p.e0230489-e0230489 |
issn | 1932-6203 1932-6203 |
language | eng |
recordid | cdi_plos_journals_2384476612 |
source | Open Access: PubMed Central; Publicly Available Content Database |
subjects | Ambulatory care facilities Amikacin Analysis Antibacterial agents Antibiotics Antimicrobial agents Antimicrobial resistance Bias Biology and Life Sciences Care and treatment Ceftriaxone Confidence intervals Drug resistance E coli Escherichia coli Gynecology Health aspects Hospitals Internal medicine Klebsiella Klebsiella pneumoniae Laboratories Malik, Adam Medicine Medicine and Health Sciences Meropenem Microbial drug resistance Microbiology Obstetrics Patients Piperacillin Piperacillin-tazobactam Pneumonia Population Prejudice Research and Analysis Methods Setting (Literature) Studies Surveillance Surveillance systems Tazobactam Trends Urinary tract Urinary tract diseases Urinary tract infections Urine Urogenital system |
title | Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia |
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