151. Joint Modeling of Resistance to Six Antimicrobials in Urinary Escherichia coli Isolates in Quebec, Canada
- Author
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David L. Buckeridge, Patrick Dolcé, Jean-Paul R. Soucy, Alexandre A. Boudreault, Alexandra M. Schmidt, Caroline Quach, and Charles Frenette
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urinary system ,Microbial Sensitivity Tests ,medicine.disease_cause ,Logistic regression ,Epidemiology and Surveillance ,resistance ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Antibiotic resistance ,Anti-Infective Agents ,Internal medicine ,Drug Resistance, Bacterial ,Credible interval ,medicine ,Escherichia coli ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Urinary Tract ,Escherichia coli Infections ,Aged ,Pharmacology ,Aged, 80 and over ,0303 health sciences ,Resistance (ecology) ,030306 microbiology ,business.industry ,Quebec ,Odds ratio ,Middle Aged ,Antimicrobial ,3. Good health ,Community-Acquired Infections ,Infectious Diseases ,laboratory data ,Urinary Tract Infections ,surveillance ,Female ,hierarchical modeling ,business - Abstract
Empirical treatment of urinary tract infections should be based on susceptibility profiles specific to the locale and patient population. Additionally, these susceptibility profiles should account for correlations between resistance to different types of antimicrobials., Empirical treatment of urinary tract infections should be based on susceptibility profiles specific to the locale and patient population. Additionally, these susceptibility profiles should account for correlations between resistance to different types of antimicrobials. We used hierarchical logistic regression models to investigate geographic, temporal, and demographic trends in resistance to six antimicrobials in community-acquired and nosocomial urinary E. coli isolates from three communities in the province of Quebec, Canada, procured between April 2010 and December 2017. A total of 74,986 community-acquired (patient age, ≥18 years) and 4,384 nosocomial isolates (patient age, ≥65 years) were analyzed. In both community-acquired and nosocomial isolates, we found geographic variation in the prevalence of resistance. Male sex (community-acquired hierarchical mean odds ratio [OR], 1.24; 95% credible interval [CI], 1.02 to 1.50; nosocomial hierarchical mean OR, 1.16, 95% CI, 0.92 to 1.41) and recent hospitalization (community-acquired hierarchical mean OR, 1.49; 95% CI, 1.33 to 1.66; nosocomial hierarchical mean OR, 1.31; 95% CI, 0.99 to 1.78) were associated with a higher risk of resistance to most types of antimicrobials. We found distinct seasonal trends in both community-acquired and nosocomial isolates, but only community-acquired isolates showed a consistent annual pattern. Ciprofloxacin resistance increased sharply with patient age. We found clinically relevant differences in antimicrobial resistance in urinary E. coli isolates between locales and patient populations in the province of Quebec. These results could help inform empirical treatment decisions for urinary tract infections. In the future, similar models integrating local, provincial, and national resistance data could be incorporated into decision support systems for clinicians.
- Published
- 2018