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

Joan A. Casey, Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Sara Y. Tartof, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Meghan F. Davis, Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Keeve E. Nachman, Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Lance Price, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Cindy Liu, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Kalvin Yu, Medical and Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA.
Vikas Gupta, Medical and Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA.
Gabriel K. Innes, Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, Yuma, Arizona, USA.
Hung Fu Tseng, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Vivian Do, Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Alice R. Pressman, Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA.
Kara E. Rudolph, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.

Document Type

Journal Article

Publication Date

2-1-2023

Journal

Environmental health perspectives

Volume

131

Issue

2

DOI

10.1289/EHP11221

Abstract

BACKGROUND: 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. OBJECTIVES: Our objective was to assess whether SB27 was associated with decreased antimicrobial resistance among isolated from human urine. METHODS: 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 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 (, 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. FINDINGS: We included 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 (-value for joint null: ), but no change in resistance to aminoglycosides, fluoroquinolones, or tetracyclines. DISCUSSION: Further research is needed to determine the role of SB27 in the observed reduction in ESC resistance in human populations, particularly as additional states implement similar legislation. https://doi.org/10.1289/EHP11221.

Department

Environmental and Occupational Health

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