{"doi":"10.1289/ehp11221","title":"Impact of a Statewide Livestock Antibiotic Use Policy on Resistance in Human Urine <i>Escherichia coli</i> Isolates: A Synthetic Control Analysis","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 E. coli 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 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 (&lt;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. Findings: 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: &lt;0.01), 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 E. coli in human populations, particularly as additional states implement similar legislation. https://doi.org/10.1289/EHP11221","journal":"Environmental Health Perspectives","year":2023,"id":357005,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9565,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":660407,"name":"Sara Y. Tartof","orcid":"0000-0003-2336-8476","position":1,"is_corresponding":false},{"id":289866,"name":"Meghan F. Davis","orcid":"0000-0002-3475-4578","position":2,"is_corresponding":false},{"id":539164,"name":"Keeve E. Nachman","orcid":"0000-0003-4925-4151","position":3,"is_corresponding":false},{"id":313738,"name":"Lance B. Price","orcid":"0000-0002-8746-5307","position":4,"is_corresponding":false},{"id":106491,"name":"Cindy H. Liu","orcid":"0000-0001-6985-5961","position":5,"is_corresponding":false},{"id":369397,"name":"Kalvin Yu","orcid":"0000-0003-4651-2012","position":6,"is_corresponding":false},{"id":898320,"name":"Vikas Gupta","orcid":"0000-0001-5291-5446","position":7,"is_corresponding":false},{"id":313736,"name":"Gabriel K. Innes","orcid":"0000-0002-8206-3608","position":8,"is_corresponding":false},{"id":371266,"name":"Hung Fu Tseng","orcid":"0000-0001-6184-6534","position":9,"is_corresponding":false},{"id":1106094,"name":"Vivian Do","orcid":"0009-0006-5633-9136","position":10,"is_corresponding":false},{"id":658999,"name":"Alice Pressman","orcid":"0000-0003-2775-3275","position":11,"is_corresponding":false},{"id":242713,"name":"Kara E. Rudolph","orcid":"0000-0002-9417-7960","position":12,"is_corresponding":false},{"id":232425,"name":"Joan A. Casey","orcid":"0000-0002-9809-4695","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":null,"created_at":"2026-07-19T01:13:30.556819Z","pmid":"36821707","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}