Mwansa Chanda M L, Babiker Ahmed, Satola Sarah, Logan Latania K, Nadimpalli Maya L
Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
JAC Antimicrob Resist. 2024 Nov 5;6(6):dlae179. doi: 10.1093/jacamr/dlae179. eCollection 2024 Dec.
Resistance to first-line antibiotics among urinary tract infections continues to rise, but how neighbourhood-level socioeconomic status impacts this risk remains unclear. We examined the effect of neighbourhood-level income on a patient's risk of having a uropathogen non-susceptible to trimethoprim/sulfamethoxazole (TMP/SMX) or nitrofurantoin.
We used electronic health record data and antibiotic susceptibility test results for urinary and collected at Emory Healthcare outpatient facilities in greater Atlanta between October 2022 and September 2023. We determined patients' block group median household income (MHI) using their residential addresses and 2017-21 US census data. We performed a logistic regression with risk factors using a generalized estimating equation, with subgroup analysis by organism and for patients with diabetes mellitus.
We included 9325 urine and isolates from 3867 outpatients. Compared to uropathogenic , were more likely to be non-susceptible to nitrofurantoin ( < 0.001) and less likely to be non-susceptible to TMP/SMX ( < 0.001). Compared to the lowest MHI quintile, patients in the highest MHI quintile neighbourhoods had 0.78 odds of harbouring a non-susceptible uropathogen (95% CI: 0.64, 0.95) after controlling for patient age, sex and race/ethnicity, along with neighbourhood-level characteristics. This association was stronger for infections and non-significant among people with diabetes.
Higher neighbourhood-level MHI was associated with lower individual risk of harbouring a first-line antibiotic-non-susceptible uropathogen.
尿路感染患者对一线抗生素的耐药性持续上升，但社区层面的社会经济地位如何影响这一风险仍不清楚。我们研究了社区层面收入对患者感染对甲氧苄啶/磺胺甲恶唑（TMP/SMX）或呋喃妥因不敏感的尿路病原体风险的影响。
我们使用了2022年10月至2023年9月在大亚特兰大地区埃默里医疗保健门诊设施收集的电子健康记录数据和尿液抗生素敏感性测试结果。我们根据患者的居住地址和2017 - 2021年美国人口普查数据确定患者所在街区组的家庭收入中位数（MHI）。我们使用广义估计方程对风险因素进行逻辑回归，并按病原体和糖尿病患者进行亚组分析。
我们纳入了9325份尿液样本和来自3867名门诊患者的分离株。与尿路致病性大肠杆菌相比，其他病原体对呋喃妥因不敏感的可能性更高（P<0.001），而对TMP/SMX不敏感的可能性更低（P<0.001）。在控制了患者年龄、性别和种族/民族以及社区层面特征后，与最低MHI五分位数组相比，最高MHI五分位数组社区的患者携带不敏感尿路病原体的几率为0.78（95%置信区间：0.64，0.95）。这种关联在大肠杆菌感染中更强，在糖尿病患者中不显著。
社区层面较高的MHI与个体携带对一线抗生素不敏感的尿路病原体的风险较低相关。
