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dc.contributor.authorKiffer, Carlos R.V.en_GB
dc.contributor.authorCamargo, Eduardo C.G.en_GB
dc.contributor.authorShimakura, Silvia E.en_GB
dc.contributor.authorRibeiro Jr, Paulo J.en_GB
dc.contributor.authorBailey, Trevor C.en_GB
dc.contributor.authorPignatari, Antonio C.C.en_GB
dc.contributor.authorMonteiro, Antonio M.V.en_GB
dc.date.accessioned2013-03-11T17:02:10Zen_GB
dc.date.accessioned2013-03-20T12:25:09Z
dc.date.issued2011en_GB
dc.description.abstractBackground 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 E. coli resistance emergence and dissemination in a major Brazilian city. A total of 4,372 urinary tract infection E. coli 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. Results E. coli 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. Conclusions 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 E. coli resistance clustering, proving that individual resistance emergence and dissemination was affected by antimicrobial population consumption.en_GB
dc.identifier.citationVol. 10, article 17en_GB
dc.identifier.doi10.1186/1476-072X-10-17en_GB
dc.identifier.urihttp://hdl.handle.net/10036/4456en_GB
dc.language.isoenen_GB
dc.publisherBioMed Centralen_GB
dc.relation.urlhttp://dx.doi.org/10.1186/1476-072X-10-17en_GB
dc.titleA spatial approach for the epidemiology of antibiotic use and resistance in community-based studies: The emergence of urban clusters of Escherichia coli quinolone resistance in Sao Paulo, Brasilen_GB
dc.typeArticleen_GB
dc.date.available2013-03-11T17:02:10Zen_GB
dc.date.available2013-03-20T12:25:09Z
dc.identifier.issn1476-072Xen_GB
dc.descriptionCopyright © Kiffer et al; licensee BioMed Central Ltd. 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.en_GB
dc.identifier.journalInternational Journal of Health Geographicsen_GB


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