Abstract：
OBJECTIVE: We aimed to quantify the individual risk of antimicrobial resistance among patients with community-acquired Escherichia coli urinary tract infection (UTI) according to their antibiotic exposure over the previous 18 months.
METHODS: French patients were prospectively recruited in two centers in 2015-2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files.
RESULTS: Previous antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20-2.21], 1.59 [1.02-2.48], 3.01 [1.90-4.77], and 2.60 [1.75-3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41-1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18]).
CONCLUSIONS: Resistance of E. coli causing UTI is partially predicted by previous personal antibiotic delivery.
METHODS: French patients were prospectively recruited in two centers in 2015-2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files.
RESULTS: Previous antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20-2.21], 1.59 [1.02-2.48], 3.01 [1.90-4.77], and 2.60 [1.75-3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41-1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18]).
CONCLUSIONS: Resistance of E. coli causing UTI is partially predicted by previous personal antibiotic delivery.
摘要：
目的：我们的目的是根据社区获得性大肠埃希菌尿路感染（UTI）患者在过去18个月内的抗生素暴露情况，量化个体对抗菌药物耐药的风险。
方法：2015-2017年在两个中心前瞻性招募了法国患者。分离株对阿莫西林（AMX）的耐药性，阿莫西林-克拉维酸（AMC），第三代头孢菌素（3GC），甲氧苄啶-磺胺甲恶唑（TMP-SMX），氟喹诺酮类(FQ)和磷霉素(FOS)根据健康保险文件中记录的以前的类内和类间抗生素暴露进行分析.
结果：在所分析的722例UTI病例（564例）中，有588例（81.4%）发现了以前的抗生素暴露。与远程暴露（UTI前18个月）相比，最近的暴露（UTI前3个月）对AMX的大肠杆菌耐药性具有更强的类内影响，AMC,FQ和TMP-SMX,相应的调整后赔率比[95%置信区间]为1.63[1.20-2.21]，1.59[1.02-2.48],3.01[1.90-4.77],和2.60[1.75-3.87]。AMX,FQ,TMP-SMX也表现出显著的类间影响。对3GC的抗性与组内暴露没有显着相关（调整后的OR：0.88[0.41-1.90]）。FOS抗性显著低(0.4%)。耐药性风险降至10%以下所需的无抗生素期持续时间，在UTI中经验使用的阈值，被建模为3GC<1个月，AMX和TMP-SMX>18个月,AMC(5.2个月[2.3至>18])和FQ(17.4个月[7.4至>18])不确定。
结论：引起UTI的E.coli的耐药性部分可以通过以前的个人抗生素使用来预测。
方法：2015-2017年在两个中心前瞻性招募了法国患者。分离株对阿莫西林（AMX）的耐药性，阿莫西林-克拉维酸（AMC），第三代头孢菌素（3GC），甲氧苄啶-磺胺甲恶唑（TMP-SMX），氟喹诺酮类(FQ)和磷霉素(FOS)根据健康保险文件中记录的以前的类内和类间抗生素暴露进行分析.
结果：在所分析的722例UTI病例（564例）中，有588例（81.4%）发现了以前的抗生素暴露。与远程暴露（UTI前18个月）相比，最近的暴露（UTI前3个月）对AMX的大肠杆菌耐药性具有更强的类内影响，AMC,FQ和TMP-SMX,相应的调整后赔率比[95%置信区间]为1.63[1.20-2.21]，1.59[1.02-2.48],3.01[1.90-4.77],和2.60[1.75-3.87]。AMX,FQ,TMP-SMX也表现出显著的类间影响。对3GC的抗性与组内暴露没有显着相关（调整后的OR：0.88[0.41-1.90]）。FOS抗性显著低(0.4%)。耐药性风险降至10%以下所需的无抗生素期持续时间，在UTI中经验使用的阈值，被建模为3GC<1个月，AMX和TMP-SMX>18个月,AMC(5.2个月[2.3至>18])和FQ(17.4个月[7.4至>18])不确定。
结论：引起UTI的E.coli的耐药性部分可以通过以前的个人抗生素使用来预测。
