E. coli bacteraemia and antimicrobial resistance following antimicrobial prescribing for urinary tract infection in the community.
Adult
Humans
Aged
Male
Female
Adolescent
Young Adult
Middle Aged
Aged, 80 and over
Anti-Bacterial Agents
/ pharmacology
Escherichia coli
Nitrofurantoin
Drug Resistance, Bacterial
Urinary Tract Infections
/ microbiology
Escherichia coli Infections
/ microbiology
Trimethoprim
Bacteremia
/ drug therapy
Amoxicillin
Microbial Sensitivity Tests
Antimicrobial resistance
Bacteraemia
Bloodstream infection
Epidemiology
Escherichia coli
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
28 Oct 2022
28 Oct 2022
Historique:
received:
27
11
2021
accepted:
06
07
2022
entrez:
29
10
2022
pubmed:
30
10
2022
medline:
2
11
2022
Statut:
epublish
Résumé
Urinary tract infections are one of the most common infections in primary and secondary care, with the majority of antimicrobial therapy initiated empirically before culture results are available. In some cases, however, over 40% of the bacteria that cause UTIs are resistant to some of the antimicrobials used, yet we do not know how the patient outcome is affected in terms of relapse, treatment failure, progression to more serious illness (bacteraemia) requiring hospitalization, and ultimately death. This study analyzed the current patterns of antimicrobial use for UTI in the community in Scotland, and factors for poor outcomes. To explore antimicrobial use for UTI in the community in Scotland, and the relationship with patient characteristics and antimicrobial resistance in E. coli bloodstream infections and subsequent mortality. We included all adult patients in Scotland with a positive blood culture with E. coli growth, receiving at least one UTI-related antimicrobial (amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim, and nitrofurantoin) between 1st January 2009 and 31st December 2012. Univariate and multivariate logistic regression analysis was performed to understand the impact of age, gender, socioeconomic status, previous community antimicrobial exposure (including long-term use), prior treatment failure, and multi-morbidity, on the occurrence of E. coli bacteraemia, trimethoprim and nitrofurantoin resistance, and mortality. There were 1,093,227 patients aged 16 to 100 years old identified as receiving at least one prescription for the 5 UTI-related antimicrobials during the study period. Antimicrobial use was particularly prevalent in the female elderly population, and 10% study population was on long-term antimicrobials. The greatest predictor for trimethoprim resistance in E. coli bacteraemia was increasing age (OR 7.18, 95% CI 5.70 to 9.04 for the 65 years old and over group), followed by multi-morbidity (OR 5.42, 95% CI 4.82 to 6.09 for Charlson Index 3+). Prior antimicrobial use, along with prior treatment failure, male gender, and higher deprivation were also associated with a greater likelihood of a resistant E. coli bacteraemia. Mortality was significantly associated with both having an E. coli bloodstream infection, and those with resistant growth. Increasing age, increasing co-morbidity, lower socioeconomic status, and prior community antibiotic exposure were significantly associated with a resistant E. coli bacteraemia, which leads to increased mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Urinary tract infections are one of the most common infections in primary and secondary care, with the majority of antimicrobial therapy initiated empirically before culture results are available. In some cases, however, over 40% of the bacteria that cause UTIs are resistant to some of the antimicrobials used, yet we do not know how the patient outcome is affected in terms of relapse, treatment failure, progression to more serious illness (bacteraemia) requiring hospitalization, and ultimately death. This study analyzed the current patterns of antimicrobial use for UTI in the community in Scotland, and factors for poor outcomes.
OBJECTIVES
OBJECTIVE
To explore antimicrobial use for UTI in the community in Scotland, and the relationship with patient characteristics and antimicrobial resistance in E. coli bloodstream infections and subsequent mortality.
METHODS
METHODS
We included all adult patients in Scotland with a positive blood culture with E. coli growth, receiving at least one UTI-related antimicrobial (amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim, and nitrofurantoin) between 1st January 2009 and 31st December 2012. Univariate and multivariate logistic regression analysis was performed to understand the impact of age, gender, socioeconomic status, previous community antimicrobial exposure (including long-term use), prior treatment failure, and multi-morbidity, on the occurrence of E. coli bacteraemia, trimethoprim and nitrofurantoin resistance, and mortality.
RESULTS
RESULTS
There were 1,093,227 patients aged 16 to 100 years old identified as receiving at least one prescription for the 5 UTI-related antimicrobials during the study period. Antimicrobial use was particularly prevalent in the female elderly population, and 10% study population was on long-term antimicrobials. The greatest predictor for trimethoprim resistance in E. coli bacteraemia was increasing age (OR 7.18, 95% CI 5.70 to 9.04 for the 65 years old and over group), followed by multi-morbidity (OR 5.42, 95% CI 4.82 to 6.09 for Charlson Index 3+). Prior antimicrobial use, along with prior treatment failure, male gender, and higher deprivation were also associated with a greater likelihood of a resistant E. coli bacteraemia. Mortality was significantly associated with both having an E. coli bloodstream infection, and those with resistant growth.
CONCLUSION
CONCLUSIONS
Increasing age, increasing co-morbidity, lower socioeconomic status, and prior community antibiotic exposure were significantly associated with a resistant E. coli bacteraemia, which leads to increased mortality.
Identifiants
pubmed: 36307776
doi: 10.1186/s12879-022-07768-7
pii: 10.1186/s12879-022-07768-7
pmc: PMC9621144
doi:
Substances chimiques
Anti-Bacterial Agents
0
Nitrofurantoin
927AH8112L
Trimethoprim
AN164J8Y0X
Amoxicillin
804826J2HU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
805Subventions
Organisme : Chief Scientist Office, Scottish Government Health and Social Care Directorate
ID : SIRN 007
Organisme : Chief Scientist Office, Scottish Government Health and Social Care Directorate
ID : SIRN 007
Organisme : Chief Scientist Office, Scottish Government Health and Social Care Directorate
ID : SIRN 007
Organisme : Chief Scientist Office, Scottish Government Health and Social Care Directorate
ID : SIRN 007
Organisme : Chief Scientist Office, Scottish Government Health and Social Care Directorate
ID : SIRN 007
Organisme : Chief Scientist Office, Scottish Government Health and Social Care Directorate
ID : SIRN 007
Informations de copyright
© 2022. The Author(s).
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