A spatial approach for the epidemiology of antibiotic use and resistance in community-based studies: the emergence of urban clusters of <it>Escherichia coli </it>quinolone resistance in Sao Paulo, Brasil

• Main Authors: Bailey Trevor C, Pignatari Antonio CC, Ribeiro Paulo J, Shimakura Silvia E, Camargo Eduardo CG, Kiffer Carlos RV, Monteiro Antonio MV
• Format: Article
• Language: English
• Published: BMC 2011-02-01
• Series: International Journal of Health Geographics
• Online Access: http://www.ij-healthgeographics.com/content/10/1/17

<p>Abstract</p> <p>Background</p> <p>Population antimicrobial use may influence resistance emergence. Resistance is an ecological phenomenon due to potential transmissibility. We investigated spatial and temporal patterns of ciprofloxacin (CIP) population consumption related to <it>E. coli </it>resistance emergence and dissemination in a major Brazilian city. A total of 4,372 urinary tract infection <it>E. coli </it>cases, with 723 CIP resistant, were identified in 2002 from two outpatient centres. Cases were address geocoded in a digital map. Raw CIP consumption data was transformed into usage density in DDDs by CIP selling points influence zones determination. A stochastic model coupled with a Geographical Information System was applied for relating resistance and usage density and for detecting city areas of high/low resistance risk.</p> <p>Results</p> <p><it>E. coli </it>CIP resistant cluster emergence was detected and significantly related to usage density at a level of 5 to 9 CIP DDDs. There were clustered hot-spots and a significant global spatial variation in the residual resistance risk after allowing for usage density.</p> <p>Conclusions</p> <p>There were clustered hot-spots and a significant global spatial variation in the residual resistance risk after allowing for usage density. The usage density of 5-9 CIP DDDs per 1,000 inhabitants within the same influence zone was the resistance triggering level. This level led to <it>E. coli </it>resistance clustering, proving that individual resistance emergence and dissemination was affected by antimicrobial population consumption.</p>