Cuningham Will, Perera Shalinie, Coulter Sonali, Nimmo Graeme R, Yarwood Trent, Tong Steven Y C, Wozniak Teresa M
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Western Diagnostic Pathology, Western Australia, Australia.
JAC Antimicrob Resist. 2021 Aug 14;3(3):dlab127. doi: 10.1093/jacamr/dlab127. eCollection 2021 Sep.
Urinary tract infections are common and are increasingly resistant to antibiotic therapy. Northern Australia is a sparsely populated region with limited access to healthcare, a relatively high burden of disease, a substantial regional and remote population, and high rates of antibiotic resistance in skin pathogens.
To explore trends in antibiotic resistance for common uropathogens and in northern Australia, and how these relate to current treatment guidelines in the community and hospital settings.
We used data from an antibiotic resistance surveillance system. We calculated the monthly and yearly percentage of isolates that were resistant in each antibiotic class, by bacterium. We analysed resistance proportions geographically and temporally, stratifying by healthcare setting. Using simple linear regression, we investigated longitudinal trends in monthly resistance proportions and correlation between community and hospital isolates.
Our analysis included 177 223 urinary isolates from four pathology providers between 2007 and 2020. Resistance to most studied antibiotics remained <20% (for and , respectively, in 2019: amoxicillin/clavulanate 16%, 5%; cefazolin 17%, 8%; nitrofurantoin 1%, 31%; trimethoprim 36%, 17%; gentamicin 7%, 2%; extended-spectrum cephalosporins 8%, 5%), but many are increasing by 1%-3% (absolute) per year. Patterns of resistance were similar between isolates from community and hospital patients.
Antibiotic resistance in uropathogens is increasing in northern Australia, but treatment guidelines generally remain appropriate for empirical therapy of patients with suspected infection (except trimethoprim in some settings). Our findings demonstrate the importance of local surveillance data (HOTspots) to inform clinical decision making and guidelines.
尿路感染很常见，并且对抗生素治疗的耐药性日益增强。澳大利亚北部人口稀少，医疗服务可及性有限，疾病负担相对较高，有大量的地区和偏远人口，且皮肤病原体的抗生素耐药率很高。
探讨澳大利亚北部常见尿路病原体的抗生素耐药趋势，以及这些趋势与社区和医院环境中当前治疗指南的关系。
我们使用了抗生素耐药监测系统的数据。我们按细菌类别计算了每类抗生素中耐药菌株的月度和年度百分比。我们对耐药比例进行了地理和时间分析，并按医疗环境进行分层。使用简单线性回归，我们研究了月度耐药比例的纵向趋势以及社区和医院分离株之间的相关性。
我们的分析纳入了2007年至2020年期间来自四家病理机构的177223份尿液分离株。对大多数研究的抗生素的耐药率仍低于20%（2019年分别为：阿莫西林/克拉维酸16%、5%；头孢唑林17%、8%；呋喃妥因1%、31%；甲氧苄啶36%、17%；庆大霉素7%、2%；广谱头孢菌素8%、5%），但许多耐药率每年以1% - 3%（绝对值）的速度上升。社区和医院患者的分离株之间的耐药模式相似。
在澳大利亚北部，尿路病原体的抗生素耐药性正在增加，但治疗指南通常仍适用于疑似感染患者的经验性治疗（某些情况下除甲氧苄啶外）。我们的研究结果表明了本地监测数据（热点）对指导临床决策和指南的重要性。
