ICES Central (Marchand-Austin, Lee, Diong, Schwartz, Brown); Public Health Ontario (Langford, Daneman, Schwartz, Allen, Johnstone, Patel, Brown); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Langford, Schwartz), and Department of Laboratory Medicine and Pathobiology (Allen, Patel), University of Toronto; Sinai Health (Johnstone), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; Ottawa Hospital Research Institute (MacFadden, Garber); University of Ottawa (Garber), Ottawa, Ont.
CMAJ Open. 2022 Dec 6;10(4):E1044-E1051. doi: 10.9778/cmajo.20210215. Print 2022 Oct-Dec.
Surveillance of antimicrobial resistance is essential to mitigate its impact on population health and inform local empiric treatment practices. Our aims were to evaluate urine culture specimen susceptibility from a range of diverse settings and describe antibiotic susceptibility across all organisms and compare susceptibilities to that of alone.
In this descriptive cohort study, we measured the prevalence of organisms in urine culture specimens using linked province-wide administrative databases. Using positive urine cultures collected in Ontario between Jan. 1, 2016, and Dec. 31, 2017, we measured susceptibility to 6 classes of antibiotics using a weighted antibiogram for all organisms compared with alone.
We included 689 497 cultures derived from 569 399 patients and 879 778 test orders for specimens. For all organisms, the rates of susceptibility in the outpatient, inpatient and long-term care settings were 49.3%, 42.8% and 39.2%, respectively, for ampicillin; 83.1%, 72.7% and 69.7%, respectively, for nitrofurantoin; 80.3%, 64.8% and 73.1%, respectively, for trimethoprim-sulfamethoxazole; 87.2%, 74.1% and 66.2%, respectively, for ciprofloxacin; 90.6%, 73.6% and 85.1%, respectively, for aminoglycosides; and 82.6%, 57.5% and 73.5%, respectively, for cefazolin. We found resistance to 3 or more antibiotic classes in 20.6% of episodes for all organisms compared with 14.0% for alone. The average absolute difference in antibiotic susceptibility between all organisms and across all drugs was lowest in the outpatient setting (6.2%) and highest in the inpatient setting (14.6%).
In this study, urinary organism prevalence and antimicrobial susceptibility varied across health care settings and patient populations, with implications for both antimicrobial resistance surveillance and clinical decision-making. Weighted antibiograms may be most useful for guiding empiric treatment of urinary infections in inpatient settings where the diversity of infectious organisms is higher than in the community.
对抗菌药物耐药性的监测对于减轻其对人群健康的影响以及为当地经验性治疗实践提供信息至关重要。我们的目的是评估来自不同环境的尿液培养标本的敏感性，并描述所有生物体的抗生素敏感性，并将其与 单独使用的敏感性进行比较。
在这项描述性队列研究中，我们使用全省范围内的行政数据库来测量尿液培养标本中生物体的流行率。使用 2016 年 1 月 1 日至 2017 年 12 月 31 日期间在安大略省采集的阳性尿液培养物，我们使用加权抗生素图测量所有生物体对 6 类抗生素的敏感性，与 单独使用进行比较。
我们纳入了 689497 份来自 569399 名患者和 879778 份标本检测订单的培养物。对于所有生物体，门诊、住院和长期护理环境中的敏感性率分别为氨苄西林的 49.3%、42.8%和 39.2%；呋喃妥因的 83.1%、72.7%和 69.7%；甲氧苄啶-磺胺甲恶唑的 80.3%、64.8%和 73.1%；环丙沙星的 87.2%、74.1%和 66.2%；氨基糖苷类药物的 90.6%、73.6%和 85.1%；头孢唑啉的 82.6%、57.5%和 73.5%。我们发现，与 单独使用相比，所有生物体的 3 种或更多种抗生素耐药的发生率为 20.6%。所有生物体与 单独使用的抗生素敏感性的平均绝对差异在门诊环境中最低（6.2%），在住院环境中最高（14.6%）。
在这项研究中，尿液中生物体的流行率和抗生素敏感性在不同的医疗保健环境和患者群体中存在差异，这对抗菌药物耐药性监测和临床决策都有影响。在住院环境中，由于感染生物体的多样性高于社区，加权抗生素图可能最有助于指导经验性治疗尿路感染。
