The Relative Impact of Community and Hospital Antibiotic Use on the Selection of Extended-spectrum Beta-lactamase-producing Escherichia coli

Clin Infect Dis. 2019 Jun 18;69(1):182-188. doi: 10.1093/cid/ciy978.


Antibiotic stewardship programs have traditionally focused on reducing hospital antibiotic use. However, reducing community antibiotic prescribing could have substantial impacts in both hospital and community settings. We developed a deterministic model of transmission of extended-spectrum beta-lactamase-producing Escherichia coli in both the community and hospitals. We fit the model to existing, national-level antibiotic use and resistance prevalence data from Sweden. Across a range of conditions, a given relative change in antibiotic use in the community had a greater impact on resistance prevalence in both the community and hospitals than an equivalent relative change in hospital use. However, on a per prescription basis, changes in antibiotic use in hospitals had the greatest impact. The magnitude of changes in prevalence were modest, even with large changes in antimicrobial use. These data support the expansion of stewardship programs/interventions beyond the walls of hospitals, but also suggest that such efforts would benefit hospitals themselves.

Keywords: antibiotic resistance; antibiotic stewardship; dynamic modeling; transmission.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship*
  • Cross Infection / drug therapy*
  • Escherichia coli / drug effects*
  • Escherichia coli / enzymology
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / enzymology
  • Escherichia coli Infections / transmission*
  • Humans
  • Models, Theoretical
  • Sweden
  • beta-Lactamases


  • Anti-Bacterial Agents
  • beta-Lactamases