Impact of a Statewide Livestock Antibiotic Use Policy on Resistance in Human Urine Escherichia coli Isolates: A Synthetic Control Analysis

• Joan A. Casey ^[1] ; Sara Y. Tartof ^[5] ; Meghan F. Davis ^[6] ; Keeve E. Nachman ^[7] ; Lance Price ^[2] ; Cindy Liu ^[2] ; Kalvin Yu ^[8] ; Vikas Gupta ^[8] ; Gabriel K. Innes ^[3] ; Hung Fu Tseng ^[9] ; Vivian Do ^[1] ; Alice R. Pressman ^[4] ; Kara E. Rudolph ^[1]
  1. [1] Columbia University

     Columbia University

     Estados Unidos

     
  2. [2] George Washington University

     George Washington University

     Estados Unidos

     
  3. [3] University of Arizona

     University of Arizona

     Estados Unidos

     
  4. [4] University of California System

     University of California System

     Estados Unidos

     
  5. [5] Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
  6. [6] Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  7. [7] Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  8. [8] 1Medical and Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
  9. [9] Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA

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• Localización: Environmental health perspectives, ISSN 0091-6765, Vol. 131, Nº. 2, 2023
• Idioma: inglés
• DOI: 10.1289/EHP11221
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• Resumen

  • On 1 January 2018, California implemented Senate Bill 27 (SB27), banning, for the first time in the United States, routine preventive use of antibiotics in food-animal production and any antibiotic use without a veterinarian’s prescription.

    Our objective was to assess whether SB27 was associated with decreased antimicrobial resistance among E. coli isolated from human urine.

    We used U.S. nationwide monthly state-level data from BD Insights Research Database (Becton, Dickinson, and Co.) spanning 1 January 2013 to 30 June 2021 on antibiotic-resistance patterns of 30-d nonduplicate E. coli isolated from urine. Tested antibiotic classes included aminoglycosides, extended-spectrum cephalosporins (ESC), fluoroquinolones, and tetracyclines. Counts of tested and not-susceptible (resistant and intermediate, hereafter resistant) urine isolates were available by sex, age group (<65, 65+ year), month, and state. We applied a synthetic control approach to estimate the causal effect of SB27 on resistance patterns. Our approach created a synthetic California based on a composite of other states without the policy change and contrasted its counterfactual postpolicy trends with the observed postpolicy trends in California.

    We included 7.1 million E. coli urine isolates, 90% among women, across 33 states. From 2013 to 2017, the median (interquartile range) resistance percentages in California were 11.9% (7.4, 17.6), 13.8% (5.8, 20.0), 24.6% (9.6, 36.4), 7.9% (2.1, 13.1), for aminoglycosides, ESC, fluoroquinolones, and tetracyclines, respectively. SB27 was associated with a 7.1% reduction in ESC resistance (p-value for joint null: <0.01), but no change in resistance to aminoglycosides, fluoroquinolones, or tetracyclines.

    Further research is needed to determine the role of SB27 in the observed reduction in ESC resistance E. coli in human populations, particularly as additional states implement similar legislation. https://doi.org/10.1289/EHP11221