Centre d'Appui à la Prévention des Infections Associées aux Soins des Pays de la Loire, Centre Hospitalier Universitaire (CHU)-Le Tourville, Nantes, France.
Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.
JAMA Netw Open. 2022 Sep 1;5(9):e2232679. doi: 10.1001/jamanetworkopen.2022.32679.
Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is considered a leading pathogen contributing to the global burden of antimicrobial resistance.
To better understand factors associated with the heterogeneity of community-acquired ESBL-producing E coli urinary tract infections (UTIs) in France.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of E coli isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included.
Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing E coli strains isolated from urine samples of individuals with community-acquired UTI in 2019.
Among 444 281 E coli isolates from urine samples tested in 1013 laboratories, the mean prevalence of ESBL-producing E coli was 3.0% (range, 1.4%-8.8%). In an adjusted model, the number of community-acquired ESBL-producing E coli UTIs in each department was positively associated with the percentage of children younger than 5 years (adjusted β1 coefficient, 0.112 [95% CI, 0.040-0.185]; P = .004), overcrowded households (adjusted β1 coefficient, 0.049 [95% CI, 0.034 to 0.062]; P < .001), consumption of fluoroquinolones (adjusted β1 coefficient, 0.002 [95% CI, 0.001-0.002]; P < .001), and tetracyclines (adjusted β1 coefficient, 0.0002 [0.00004 to 0.00039]; P = .02), and poultry density (adjusted β1 coefficient, 0.0001 [95% CI, 0.0001-0.0002]; P < .001). The social deprivation index (adjusted β1 coefficient, -0.115 [95% CI, -0.165 to -0.064]; P < .001) and the proportion of water surface area (adjusted β1 coefficient, -0.052 [-0.081 to -0.024]; P = .001) were negatively associated with a higher number of community-acquired ESBL-producing E coli UTIs.
The findings of this cross-sectional study suggest that multiple human health, animal health, and environmental factors are associated with the occurence of community-acquired ESBL E coli UTI. Strategies to mitigate ESBL in the community should follow the One Health approach and address the role played by fluoroquinolones, tetracycline use, poultry density, overcrowded households, and preschool-aged children.
产超广谱β-内酰胺酶（ESBL）的大肠杆菌被认为是导致全球抗菌药物耐药负担的主要病原体之一。
更好地了解与法国社区获得性产 ESBL 大肠杆菌尿路感染（UTI）异质性相关的因素。
设计、地点和参与者：本横断面研究于 2021 年 1 月 1 日至 12 月 31 日进行，基于通过 PRIMO（初级保健和养老院中抗菌药物耐药性的监测和预防）收集的数据，这是法国一个全国性的临床实验室监测系统。纳入了来自法国大都市 59 个行政区的社区尿液样本中分离的大肠杆菌菌株。
使用拟泊松回归模型评估了 2010 年至 2020 年政府和管理网站上提供的几个生态因素（人口结构、生活条件、基线医疗保健服务、抗生素消费、经济指标、动物养殖密度和环境特征）与 2019 年社区获得性 UTI 个体尿液样本中分离的产 ESBL 大肠杆菌菌株数量之间的关联。
在 1013 个实验室检测的 444281 个大肠杆菌尿样中，产 ESBL 大肠杆菌的平均流行率为 3.0%（范围，1.4%-8.8%）。在调整模型中，每个部门的社区获得性产 ESBL 大肠杆菌 UTI 数量与 5 岁以下儿童的比例呈正相关（调整后β1系数，0.112[95%CI，0.040-0.185]；P=0.004），家庭拥挤（调整后β1系数，0.049[95%CI，0.034-0.062]；P<0.001），氟喹诺酮类药物的消费（调整后β1系数，0.002[95%CI，0.001-0.002]；P<0.001）和四环素（调整后β1系数，0.0002[0.00004 至 0.00039]；P=0.02），以及家禽密度（调整后β1系数，0.0001[95%CI，0.0001-0.0002]；P<0.001）。社会剥夺指数（调整后β1系数，-0.115[95%CI，-0.165 至 -0.064]；P<0.001）和水面面积比例（调整后β1系数，-0.052[-0.081 至 -0.024]；P=0.001）与社区获得性产 ESBL 大肠杆菌 UTI 的数量呈负相关。
这项横断面研究的结果表明，多种人类健康、动物健康和环境因素与社区获得性产 ESBL 大肠杆菌 UTI 的发生有关。减少社区中 ESBL 的策略应遵循同一健康方法，并解决氟喹诺酮类药物、四环素使用、家禽密度、家庭拥挤和学龄前儿童的作用。
