Watts Vicky, Brown Benjamin, Ahmed Maria, Charlett André, Chew-Graham Carolyn, Cleary Paul, Decraene Valerie, Dodgson Kirsty, George Ryan, Hopkins Susan, Esmail Aneez, Welfare William
Field Service North West, National Infection Service, Public Health England, Liverpool, UK.
Centre for Primary Care, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
JAC Antimicrob Resist. 2020 May 27;2(2):dlaa022. doi: 10.1093/jacamr/dlaa022. eCollection 2020 Jun.
To assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data.
All patients aged ≥18years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates.
Sentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21-35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were (113/169) Non-susceptibility of to trimethoprim was 28.2% (95% CI 20.2-37.7) on sentinel surveillance (33.4%; 95% CI 29.5-37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0-5.7) (1.5%; 95% CI 0.7-3.0 on routine data).
Routine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.
评估从社区获得性尿路感染（UTI）的抗菌药物耐药性（AMR）哨点监测获得的耐药性估计值是否与常规收集的实验室社区UTI数据不同。
2017年11月13日至2018年2月12日期间，所有年龄≥18岁、因疑似UTI就诊于四家哨点全科诊所的患者均被要求提供尿液标本进行培养和药敏试验。标本在当地诊断实验室进行处理。使用自动化方法进行抗生素药敏试验。我们计算了对甲氧苄啶、呋喃妥因、头孢氨苄、环丙沙星和阿莫西林/克拉维酸不敏感（根据同期欧盟CAST指南）的分离株比例，总体及按年龄组和性别进行计算，并将其与常规估计值进行比较。
哨点诊所提交了740份合格标本。标本提交率每年每1000人口增加28份标本（95%CI 21-35）。从23%（169/740）的标本中分离出尿路病原体；67%为……哨点监测中对甲氧苄啶的不敏感率为28.2%（95%CI 20.2-37.7）（常规数据为33.4%；95%CI 29.5-37.6），对呋喃妥因的不敏感率为0.9%（95%CI 0-5.7）（常规数据为1.5%；95%CI 0.7-3.0）。
常规实验室数据导致耐药性略有高估（尽管差异无统计学意义），我们的研究结果表明，它能充分估计英格兰社区获得性UTI中对关键抗菌药物的不敏感性。本研究不支持进行持续的当地哨点监测。
