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  • Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey

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Infectious diseases
Research
Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey
  1. Yin Mo1,2,
  2. Ivan Seah3,
  3. Pei Shi Priscillia Lye3,
  4. Xiang Lee Jamie Kee3,
  5. Kien Yee Michael Wong3,
  6. Kwan Ki Karrie Ko4,
  7. Rick Twee-Hee Ong5,
  8. Paul A Tambyah1,6,
  9. Alex R Cook5
  1. 1 Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
  2. 2 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
  3. 3 National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
  4. 4 Department of Microbiology, Singapore General Hospital, Singapore, Singapore
  5. 5 National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
  6. 6 Department of Medicine, National University of Singapore, Singapore, Singapore
  1. Correspondence to Dr Yin Mo; yin_mo{at}nuhs.edu.sg

Abstract

Objectives To study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors and public health interventions to reduce prevalence of multidrug-resistant organism colonisation in the community.

Design Cross-sectional questionnaire of KAP towards antibiotic use and collection of stool samples or rectal swabs. ESBL-PE isolates obtained underwent whole genome sequencing to identify resistance genes.

Setting A densely populated community in Singapore.

Participants There were 693 healthy community-dwelling questionnaire respondents. Out of which, 305 provided stool samples or rectal swabs.

Results The overall knowledge of antibiotic use was poor (mean score 4.6/10, IQR 3.0–6.0). 80 participants (80/305, 26.2%) carried at least one ESBL-PE isolate. The most common ESBL-PE was Escherichia coli sequence type 131 carrying CTX-M type beta-lactamases (11/71, 15.5%). Living overseas for >1 year (OR 3.3, 95% CI 1.6 to 6.9) but not short-term travel, recent hospitalisation or antibiotic intake was associated with ESBL-PE carriage. Interestingly, higher knowledge scores (OR 2.0, 95% CI 1.03 to 3.9) and having no leftover antibiotics (OR 2.4, 95% CI 1.2 to 4.9) were independent factors associated with ESBL-PE carriage in the multivariate logistic regression model.

Conclusions While the role of trans-border transmission of antimicrobial resistance is well known, we may have to examine the current recommendation that all antibiotics courses have to be completed. Clinical trials to determine the optimum duration of treatment for common infections are critically important.

  • extended-spectrum beta-lactamase producing enterobacteriaceae
  • antimicrobial resistance
  • duration of antibiotic treatment

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023859

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    Footnotes

    • YM and IS contributed equally.

    • Contributors YM, PT, ARC, IS, PSPL, XLJK and KYMW conceptualised and designed the study. IS, PSPL, XLJK and KYMW conducted the study and collected data. KKKK performed microbiological testing. RTHO planned and conducted genomic sequencing and interpreted the results. YM, ARC, IS, PSPL, XLJK and KYMW performed data analysis. All participated in the writing of the script, and affirm that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as originally planned have been explained. YM and IS accept full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and no others meeting the criteria have been omitted.

    • Funding Data collection was supported from funding from the Infectious Diseases Research Fund, National University of Singapore (NUS) and the Saw Swee Hock School of Public Health (SSHSPH). RT-HO received funding support from the SSHSPH, NUS. ARC was supported by the Singapore Ministry of Health’s National Medical Research Council under the Centre Grant Programme—Singapore Population Health Improvement Centre (NMRC/CG/C026/2017_NUHS).

    • Competing interests None declared.

    • Ethics approval Ethical approval was obtained from National University of Singapore Institutional Review Board (reference number B-16–245).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors commit to making the relevant anonymised patient-level data available on reasonable request.

    • Patient consent for publication Not required.