Abstract：
We investigated whether prior use of antibiotics affects the risk of mecillinam/trimethoprim/nitrofurantoin/multi-resistant Escherichia coli urinary tract infection (UTI) among elderly patients in general practice. Data on urine culture came from urine samples performed in general practice and sent to hospitals in the Capital Region of Denmark, and prescription data came from a nationwide prescription database. The study population consisted of patients with UTI episodes (n = 41,027) caused by E. coli that received a concurrent antibiotic prescription against UTI from 2012 to 2017. We used a case-control design. Cases were UTI episodes caused by mecillinam, trimethoprim, nitrofurantoin or multi-resistant E. coli and controls were UTI episodes caused by E. coli not displaying the respective resistance pattern. We analyzed whether exposure to antibiotics in a period of 8-90 days prior to the UTI episode affected the risk of antibiotic resistant uropathogenic E coli. The analyses were adjusted for age, sex, hospital admission and nursing home status. The odds of resistance to all of the four antibiotics increased significantly after exposure to antibiotics within 90 days prior to the UTI episode. In general, mecillinam showed the lowest increase in the odds for selection of resistance. The results indicate that mecillinam is a favorable antibiotic choice in terms of selection of resistance.
摘要：
我们调查了在一般实践中，在老年患者中，先前使用抗生素是否会影响美西林/甲氧苄啶/呋喃妥因/多重耐药大肠杆菌尿路感染（UTI）的风险。尿液培养的数据来自一般实践中进行的尿液样本，并送往丹麦首都地区的医院，处方数据来自全国的处方数据库。研究人群包括由大肠杆菌引起的UTI发作的患者（n=41,027），这些患者在2012年至2017年期间同时接受了针对UTI的抗生素处方。我们使用了病例对照设计。病例是由mecillinam引起的UTI发作，甲氧苄啶,呋喃妥因或多重耐药的大肠杆菌和对照是由未显示各自耐药模式的大肠杆菌引起的UTI发作.我们分析了UTI发作前8-90天的抗生素暴露是否会影响抗生素耐药性尿路致病性大肠杆菌的风险。分析根据年龄进行了调整，性别,入院和疗养院状况。在UTI发作前90天内暴露于抗生素后，对所有四种抗生素的耐药几率显着增加。总的来说,mecillinam显示选择抗性的几率最低。结果表明，就抗性选择而言，mecilinam是一种有利的抗生素选择。
