1. Individual health insurance data of antibiotic delivery in previous months as a tool to predict bacterial resistance of urinary tract infection: A prospective cohort study.
- Author
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Alexandre K, Gillibert A, Dahyot S, Fabre R, Kuhn F, Benichou J, Delbos V, and Caron F
- Subjects
- Humans, Prospective Studies, Female, Male, Middle Aged, Aged, Insurance, Health statistics & numerical data, France epidemiology, Community-Acquired Infections drug therapy, Community-Acquired Infections microbiology, Community-Acquired Infections epidemiology, Adult, Fosfomycin therapeutic use, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Cohort Studies, Aged, 80 and over, Amoxicillin-Potassium Clavulanate Combination therapeutic use, Urinary Tract Infections drug therapy, Urinary Tract Infections microbiology, Urinary Tract Infections epidemiology, Anti-Bacterial Agents therapeutic use, Escherichia coli drug effects, Escherichia coli isolation & purification, Drug Resistance, Bacterial, Escherichia coli Infections drug therapy, Escherichia coli Infections epidemiology
- Abstract
Objectives: We aimed to quantify the individual risk of antimicrobial resistance among patients with community-acquired Escherichia coli urinary tract infection (UTI) according to their antibiotic exposure over the previous 18 months., Patients and Methods: French patients were prospectively recruited in two centers in 2015-2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files., Results: Previous antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20-2.21], 1.59 [1.02-2.48], 3.01 [1.90-4.77], and 2.60 [1.75-3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41-1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18])., Conclusions: Resistance of E. coli causing UTI is partially predicted by previous personal antibiotic delivery., (Copyright © 2024. Published by Elsevier Masson SAS.)
- Published
- 2024
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