William Malcolm1, Eilidh Fletcher2, Kimberley Kavanagh3, Ashutosh Deshpande4, Camilla Wiuff1, Charis Marwick5, Marion Bennie2,6. 1. Health Protection Scotland, NHS National Services Scotland, Glasgow, UK. 2. Information Services Division, NHS National Services Scotland, Edinburgh, UK. 3. Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK. 4. Microbiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK. 5. Population Health Sciences, University of Dundee, Dundee, UK. 6. Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK.
Abstract
BACKGROUND: Urinary tract infections (UTIs) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections. OBJECTIVES: To characterize risk factors for antibiotic-resistant community urine isolates using routine record-linked health data. METHODS: Within the NHS Scotland Infection Intelligence Platform, national surveillance patient-level data on community urine isolates (January 2012-June 2015) were linked to hospital activity and community prescribing data. Associations between age, gender, comorbidity, care home residence, previous hospitalizations, antibiotic exposure and resistant (any antibiotic) or MDR (≥1 antibiotic from ≥3 categories) urinary isolates were quantified using multivariable logistic regression. RESULTS: Of 40984 isolates, 28% were susceptible, 45% were resistant and 27% were MDR. Exposure to ≥ 4 different antibiotics in the prior 6 months increased MDR risk (OR 6.81, 95% CI 5.73-8.11). MDR was associated with ≥29 DDD cumulative exposure, in the prior 6 months, for any antibiotic (OR 6.54, 95% CI 5.88-7.27), nitrofurantoin (OR 8.56, 95% CI 6.56-11.18) and trimethoprim (OR 14.61, 95% CI 10.53-20.27). Associations persisted for 10-12 months for nitrofurantoin (OR 2.31, 95% CI 1.93-2.76) and trimethoprim (OR 1.81, 95% CI 1.57-2.09). Increasing age, comorbidity, previous hospitalization and care home residence were independently associated with MDR. For resistant isolates the factors were the same, but with weaker associations. CONCLUSIONS: To our knowledge, we have demonstrated, using national capability at scale, the risk of MDR in community urine isolates for the first time and quantified the cumulative and sustained impact of antibiotic exposure. These data will inform the development of decision support tools for UTI treatment.
BACKGROUND: Urinary tract infections (UTIs) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections. OBJECTIVES: To characterize risk factors for antibiotic-resistant community urine isolates using routine record-linked health data. METHODS: Within the NHS Scotland Infection Intelligence Platform, national surveillance patient-level data on community urine isolates (January 2012-June 2015) were linked to hospital activity and community prescribing data. Associations between age, gender, comorbidity, care home residence, previous hospitalizations, antibiotic exposure and resistant (any antibiotic) or MDR (≥1 antibiotic from ≥3 categories) urinary isolates were quantified using multivariable logistic regression. RESULTS: Of 40984 isolates, 28% were susceptible, 45% were resistant and 27% were MDR. Exposure to ≥ 4 different antibiotics in the prior 6 months increased MDR risk (OR 6.81, 95% CI 5.73-8.11). MDR was associated with ≥29 DDD cumulative exposure, in the prior 6 months, for any antibiotic (OR 6.54, 95% CI 5.88-7.27), nitrofurantoin (OR 8.56, 95% CI 6.56-11.18) and trimethoprim (OR 14.61, 95% CI 10.53-20.27). Associations persisted for 10-12 months for nitrofurantoin (OR 2.31, 95% CI 1.93-2.76) and trimethoprim (OR 1.81, 95% CI 1.57-2.09). Increasing age, comorbidity, previous hospitalization and care home residence were independently associated with MDR. For resistant isolates the factors were the same, but with weaker associations. CONCLUSIONS: To our knowledge, we have demonstrated, using national capability at scale, the risk of MDR in community urine isolates for the first time and quantified the cumulative and sustained impact of antibiotic exposure. These data will inform the development of decision support tools for UTI treatment.
Authors: Manuel Madrazo; Ana Esparcia; Ian López-Cruz; Juan Alberola; Laura Piles; Alba Viana; José María Eiros; Arturo Artero Journal: BMC Infect Dis Date: 2021-12-07 Impact factor: 3.090