Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia; Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, NSW, Australia.
Australian Capital Territory (ACT) Pathology, Canberra Hospital and Health Services, Australian Capital Territory, Australia.
J Glob Antimicrob Resist. 2019 Mar;16:254-259. doi: 10.1016/j.jgar.2018.10.026. Epub 2018 Nov 6.
The aim of this study was to evaluate the incidence of single-drug resistant, multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) Escherichia coli urinary tract infections (UTIs) in a sample of Australian Capital Territory (ACT) residents.
Laboratory-based retrospective data from all ACT residents whose urine samples were processed from January 2009 to December 2013 at ACT Pathology were utilised. Multivariate logistic regression models were constructed to determine the associations of age, sex, urine sample source and socioeconomic status with risk of resistant infections.
A total of 146 915 urine samples from 57 837 ACT residents were identified over 5 years. The mean±standard deviation age of residents at first sample submitted was 48±26years, and 64.4% were female. The 5-year incidence of single-drug resistant E. coli UTI was high for ampicillin, trimethoprim and cefazolin (6.8%, 3.5% and 1.9%, respectively). No PDR E. coli UTI was detected. Five-year incidences of MDR and XDR E. coli UTIs were 1.9% and 0.2%, respectively, which is low in comparison with international rates. Female sex and age ≥38 years were significantly associated with single-drug and multidrug resistance. The risk of single-drug resistance was significantly higher in samples from after-hours general practice (GP) clinics compared with hospitals, office-hours GP clinics, and community and specialist health services (adjusted odds ratio=2.6, 95% confidence interval 2.2-3.1).
These findings have significant implications for antimicrobial prescribing given the identified risk factors for the detection of resistance, especially in patients attending after-hours GP clinics.
本研究旨在评估澳大利亚首都地区（ACT）居民样本中单药耐药、多药耐药（MDR）、广泛耐药（XDR）和泛耐药（PDR）大肠埃希菌尿路感染（UTI）的发生率。
利用 2009 年 1 月至 2013 年 12 月期间在 ACT 病理学实验室处理的所有 ACT 居民的尿液样本的基于实验室的回顾性数据。构建多变量逻辑回归模型，以确定年龄、性别、尿液样本来源和社会经济地位与耐药感染风险的关系。
在 5 年期间，从 57837 名 ACT 居民中确定了 146915 份尿液样本。居民首次提交样本的平均年龄±标准差为 48±26 岁，64.4%为女性。5 年内，氨苄西林、甲氧苄啶和头孢唑林治疗的大肠埃希菌 UTI 单药耐药率分别为 6.8%、3.5%和 1.9%，非常高。未检测到 PDR 大肠埃希菌 UTI。5 年内 MDR 和 XDR 大肠埃希菌 UTI 的发生率分别为 1.9%和 0.2%，与国际水平相比较低。女性和年龄≥38 岁与单药和多药耐药显著相关。与医院、门诊医生诊所、社区和专科卫生服务相比，夜间全科医生诊所样本中单药耐药的风险显著更高（调整后的优势比=2.6，95%置信区间 2.2-3.1）。
鉴于所确定的耐药检测风险因素，这些发现对抗菌药物的应用具有重要意义，尤其是在夜间全科医生诊所就诊的患者中。
