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Title: Effect of outpatient antibiotics for urinary tract infections on antimicrobial resistance among commensal Enterobacteriaceae: a multinational prospective cohort study.
Austin Authors: Stewardson, Andrew J;Vervoort, J;Adriaenssens, N;Coenen, S;Godycki-Cwirko, M;Kowalczyk, A;Huttner, B D;Lammens, C;Malhotra-Kumar, S;Goossens, H;Harbarth, S
Affiliation: Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Infectious Diseases, Monash University and Alfred Health, Melbourne, Australia
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
Faculty of Health Sciences, Division of Public Health, Medical University of Lodz, Łódź, Poland
Centre for Family and Community Medicine, Medical University of Lodz, Łódź, Poland
Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Issue Date: 10-Jan-2018 2018-01-10
Publication information: Clinical microbiology and infection 2018; 24(9): 972-979
Abstract: We quantified the impact of antibiotics prescribed in primary care for urinary tract infections (UTIs) on intestinal colonization by ciprofloxacin-resistant (CIP-RE) and extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), while accounting for household clustering. Prospective cohort study from January 2011 to August 2013 at primary care sites in Belgium, Poland and Switzerland. We recruited outpatients requiring antibiotics for suspected UTIs or asymptomatic bacteriuria (exposed patients), outpatients not requiring antibiotics (non-exposed patients), and one to three household contacts for each patient. Faecal samples were tested for CIP-RE, ESBL-PE, nitrofurantoin-resistant Enterobacteriaceae (NIT-RE) and any Enterobacteriaceae at baseline (S1), end of antibiotics (S2) and 28 days after S2 (S3). We included 300 households (205 exposed, 95 non-exposed) with 716 participants. Most exposed patients received nitrofurans (86; 42%) or fluoroquinolones (76; 37%). CIP-RE were identified in 16% (328/2033) of samples from 202 (28%) participants. Fluoroquinolone treatment caused transient suppression of Enterobacteriaceae (S2) and subsequent two-fold increase in CIP-RE prevalence at S3 (adjusted prevalence ratio (aPR) 2.0, 95% CI 1.2-3.4), with corresponding number-needed-to-harm of 12. Nitrofurans had no impact on CIP-RE (aPR 1.0, 95% CI 0.5-1.8) or NIT-RE. ESBL-PE were identified in 5% (107/2058) of samples from 71 (10%) participants, with colonization not associated with antibiotic exposure. Household exposure to CIP-RE or ESBL-PE was associated with increased individual risk of colonization: aPR 1.8 (95% CI 1.3-2.5) and 3.4 (95% CI 1.3-9.0), respectively. These findings support avoidance of fluoroquinolones for first-line UTI therapy in primary care, and suggest potential for interventions that interrupt household circulation of resistant Enterobacteriaceae.
DOI: 10.1016/j.cmi.2017.12.026
PubMed URL: 29331548
Type: Journal Article
Subjects: Antimicrobial resistance
Collateral damage
Extended-spectrum β-lactamase
Urinary tract infection
Appears in Collections:Journal articles

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