Health Protection Scotland, NHS National Services Scotland, Glasgow, UK.
Information Services Division, NHS National Services Scotland, Edinburgh, UK.
J Antimicrob Chemother. 2018 Jan 1;73(1):223-230. doi: 10.1093/jac/dkx363.
Urinary tract infections (UTIs) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections.
To characterize risk factors for antibiotic-resistant community urine isolates using routine record-linked health data.
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.
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.
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.
尿路感染（UTI）很常见。抗生素治疗通常是经验性的，存在治疗耐药感染不足的风险。
利用常规记录链接的健康数据来描述社区尿液分离物中抗生素耐药的危险因素。
在苏格兰国民保健系统感染情报平台内，对 2012 年 1 月至 2015 年 6 月期间社区尿液分离物的全国监测患者水平数据进行了链接，这些数据与医院活动和社区处方数据相关联。使用多变量逻辑回归来量化年龄、性别、合并症、养老院居住、以前的住院治疗、抗生素暴露与耐药（任何抗生素）或 MDR（≥ 3 种抗生素中的≥ 1 种抗生素）尿液分离物之间的关联。
在 40984 个分离物中，28%是敏感的，45%是耐药的，27%是 MDR 的。在过去 6 个月内接触≥ 4 种不同抗生素会增加 MDR 风险（比值比 6.81，95%CI 5.73-8.11）。在过去 6 个月内，MDR 与任何抗生素（比值比 6.54，95%CI 5.88-7.27）、呋喃妥因（比值比 8.56，95%CI 6.56-11.18）和甲氧苄啶（比值比 14.61，95%CI 10.53-20.27）的≥ 29 DDD 累积暴露相关。对于呋喃妥因（比值比 2.31，95%CI 1.93-2.76）和甲氧苄啶（比值比 1.81，95%CI 1.57-2.09），这种关联持续了 10-12 个月。年龄增加、合并症、以前的住院治疗和养老院居住与 MDR 独立相关。对于耐药分离物，相关因素相同，但关联较弱。
据我们所知，我们首次使用全国范围内的大规模能力证明了社区尿液分离物中 MDR 的风险，并量化了抗生素暴露的累积和持续影响。这些数据将为 UTI 治疗决策支持工具的开发提供信息。
