{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T03:16:00Z","timestamp":1785640560376,"version":"3.56.0"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>The aim of this study was to develop a logistic modeling concept to improve understanding of the relationship between antibiotic use thresholds and the incidence of resistant pathogens. A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-level incidence rates of extended-spectrum \u03b2-lactamase (ESBL)-producing Escherichia coli (E. coli). Threshold logistic models identified thresholds for fluoroquinolones (61.1 DDD\/1000 occupied bed days (OBD)) and third-generation cephalosporins (9.2 DDD\/1000 OBD) to control hospital ESBL-producing E. coli incidence. The 60th percentile of ESBL-producing E. coli was determined as the cutoff for defining high incidence rates. Threshold logistic analysis showed that for every one-unit increase in fluoroquinolones and third-generation cephalosporins above 61.1 and 9.2 DDD\/1000 OBD levels, the average odds of the ESBL-producing E. coli incidence rate being \u226560th percentile of historical levels increased by 4.5% and 12%, respectively. Threshold logistic models estimated the risk scores of exceeding the 60th percentile of a historical ESBL-producing E. coli incidence rate. Threshold logistic models can help hospitals in defining critical levels of antibiotic use and resistant pathogen incidence and provide targets for antibiotic consumption and a near real-time performance monitoring feedback system.<\/jats:p>","DOI":"10.3390\/antibiotics11081116","type":"journal-article","created":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T21:23:56Z","timestamp":1660771436000},"page":"1116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Identifying Antibiotic Use Targets for the Management of Antibiotic Resistance Using an Extended-Spectrum \u03b2-Lactamase-Producing Escherichia coli Case: A Threshold Logistic Modeling Approach"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8148-7612","authenticated-orcid":false,"given":"Mamoon A.","family":"Aldeyab","sequence":"first","affiliation":[{"name":"Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9640-2474","authenticated-orcid":false,"given":"Stuart E.","family":"Bond","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK"},{"name":"Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5570-3318","authenticated-orcid":false,"given":"Barbara R.","family":"Conway","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK"},{"name":"Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9588-9433","authenticated-orcid":false,"given":"Jade","family":"Lee-Milner","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9644-4842","authenticated-orcid":false,"given":"Jayanta B.","family":"Sarma","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Lattyak","sequence":"additional","affiliation":[{"name":"Scientific Computing Associates Corp., River Forest, IL 60305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Babar, Z.U.D. 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