[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]
Joint modelling of resistance to six antimicrobials in urinary Escherichia coliisolates in Quebec, Canada
Jean-Paul R. Soucy, Alexandra M. Schmidt, Charles Frenette, Patrick Dolcé, Alexandre A. Boudreault, David L. Buckeridge, Caroline Quach
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 (age ≥ 18) and 4,384 nosocomial isolates (age ≥ 65) were analyzed. In both community-acquired and nosocomial isolates, we found geographic variation in the prevalence of resistance. Male sex (community-acquired hierarchical mean OR = 1.24, 95% credible interval: 1.02–1.50; nosocomial hierarchical mean OR = 1.16, 95% CI: 0.92–1.41) and recent hospitalization (community-acquired hierarchical mean OR = 1.49, 95% CI: 1.33–1.66; nosocomial hierarchical mean OR = 1.31, 95% CI: 0.99–1.78) 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.
Copyright © 2019 Soucy et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.
Keywords: Antibiotics; Drugs Resistance; E. Coli; Ciprofloxacin; Canada; UTI.