Risk factors for resistance and multidrug resistance in community urine isolates: population level analysis using the NHS Scotland Infection Intelligence Platform

William Malcolm, Eilidh Fletcher, Kimberley Kavanagh, Ashutosh Deshpande, Camilla Wiuff, Charis Marwick, Marion Bennie

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Urinary tract infections (UTI) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections.
Objectives: To characterise risk factors for antibiotic resistant community urine isolates using routine record linked health data.
Methods: Within the National Health Service Scotland Infection Intelligence Platform, national surveillance patient-level data on community urine isolates (January 2012-June 2015) were linked to hospital activity and community prescribing data. Associations between age, gender, comorbidity, care home residence, previous hospitalisations, antibiotic exposure, and resistant (any antibiotic) or MDR (≥1 antibiotic from ≥3 categories) urinary isolates were quantified using multivariable logistic regression.
Results: Of 40,984 isolates, 28% were susceptible, 45% resistant, and 27% MDR. Exposure to ≥ 4 different antibiotics in the prior six months increased MDR risk, OR 6.81 (95%CI 5.73-8.11). MDR was associated with ≥29 DDD cumulative exposure, in the prior six months, for any antibiotic (OR 6.54, 95%CI 5.88-7.27), nitrofurantoin (OR 8.56, 95%CI 6.56-11.18) and trimethoprim (OR 14.61, 95%CI10.53-20.27). Associations persisted for 10-12 months for nitrofurantoin (OR 2.31, 95%CI 1.93-2.76) and trimethoprim (OR 1.81, 95%CI 1.57-2.09). Increasing age, comorbidity, previous hospitalisation and care home residence were independently associated with MDR. For resistant isolates the factors were the same but with weaker associations.
Conclusion: We have demonstrated, using national capability at scale, the risk of MDR in community urine isolates for the first time and quantified the cumulative and sustained impact of antibiotic exposure. These data will inform the development of decision support tools for UTI treatment.
LanguageEnglish
Number of pages21
JournalJournal of Antimicrobial Chemotherapy
Early online date10 Oct 2017
DOIs
Publication statusE-pub ahead of print - 10 Oct 2017

Fingerprint

Scotland
Multiple Drug Resistance
Intelligence
Urine
Anti-Bacterial Agents
Infection
Population
Nitrofurantoin
Trimethoprim
Home Care Services
Urinary Tract Infections
Comorbidity
Hospitalization
Dichlorodiphenyldichloroethane
National Health Programs
Therapeutics
Logistic Models
Health

Keywords

  • urine isolates
  • antibiotic resistance
  • urinary tract infections

Cite this

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title = "Risk factors for resistance and multidrug resistance in community urine isolates: population level analysis using the NHS Scotland Infection Intelligence Platform",
abstract = "Background: Urinary tract infections (UTI) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections. Objectives: To characterise risk factors for antibiotic resistant community urine isolates using routine record linked health data. Methods: Within the National Health Service Scotland Infection Intelligence Platform, national surveillance patient-level data on community urine isolates (January 2012-June 2015) were linked to hospital activity and community prescribing data. Associations between age, gender, comorbidity, care home residence, previous hospitalisations, antibiotic exposure, and resistant (any antibiotic) or MDR (≥1 antibiotic from ≥3 categories) urinary isolates were quantified using multivariable logistic regression.Results: Of 40,984 isolates, 28{\%} were susceptible, 45{\%} resistant, and 27{\%} MDR. Exposure to ≥ 4 different antibiotics in the prior six months increased MDR risk, OR 6.81 (95{\%}CI 5.73-8.11). MDR was associated with ≥29 DDD cumulative exposure, in the prior six months, for any antibiotic (OR 6.54, 95{\%}CI 5.88-7.27), nitrofurantoin (OR 8.56, 95{\%}CI 6.56-11.18) and trimethoprim (OR 14.61, 95{\%}CI10.53-20.27). Associations persisted for 10-12 months for nitrofurantoin (OR 2.31, 95{\%}CI 1.93-2.76) and trimethoprim (OR 1.81, 95{\%}CI 1.57-2.09). Increasing age, comorbidity, previous hospitalisation and care home residence were independently associated with MDR. For resistant isolates the factors were the same but with weaker associations. Conclusion: We have demonstrated, using national capability at scale, the risk of MDR in community urine isolates for the first time and quantified the cumulative and sustained impact of antibiotic exposure. These data will inform the development of decision support tools for UTI treatment.",
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Risk factors for resistance and multidrug resistance in community urine isolates : population level analysis using the NHS Scotland Infection Intelligence Platform. / Malcolm, William; Fletcher, Eilidh; Kavanagh, Kimberley; Deshpande, Ashutosh; Wiuff, Camilla; Marwick, Charis; Bennie, Marion.

In: Journal of Antimicrobial Chemotherapy, 10.10.2017.

Research output: Contribution to journalArticle

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T1 - Risk factors for resistance and multidrug resistance in community urine isolates

T2 - Journal of Antimicrobial Chemotherapy

AU - Malcolm, William

AU - Fletcher, Eilidh

AU - Kavanagh, Kimberley

AU - Deshpande, Ashutosh

AU - Wiuff, Camilla

AU - Marwick, Charis

AU - Bennie, Marion

PY - 2017/10/10

Y1 - 2017/10/10

N2 - Background: Urinary tract infections (UTI) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections. Objectives: To characterise risk factors for antibiotic resistant community urine isolates using routine record linked health data. Methods: Within the National Health Service Scotland Infection Intelligence Platform, national surveillance patient-level data on community urine isolates (January 2012-June 2015) were linked to hospital activity and community prescribing data. Associations between age, gender, comorbidity, care home residence, previous hospitalisations, antibiotic exposure, and resistant (any antibiotic) or MDR (≥1 antibiotic from ≥3 categories) urinary isolates were quantified using multivariable logistic regression.Results: Of 40,984 isolates, 28% were susceptible, 45% resistant, and 27% MDR. Exposure to ≥ 4 different antibiotics in the prior six months increased MDR risk, OR 6.81 (95%CI 5.73-8.11). MDR was associated with ≥29 DDD cumulative exposure, in the prior six months, for any antibiotic (OR 6.54, 95%CI 5.88-7.27), nitrofurantoin (OR 8.56, 95%CI 6.56-11.18) and trimethoprim (OR 14.61, 95%CI10.53-20.27). Associations persisted for 10-12 months for nitrofurantoin (OR 2.31, 95%CI 1.93-2.76) and trimethoprim (OR 1.81, 95%CI 1.57-2.09). Increasing age, comorbidity, previous hospitalisation and care home residence were independently associated with MDR. For resistant isolates the factors were the same but with weaker associations. Conclusion: We have demonstrated, using national capability at scale, the risk of MDR in community urine isolates for the first time and quantified the cumulative and sustained impact of antibiotic exposure. These data will inform the development of decision support tools for UTI treatment.

AB - Background: Urinary tract infections (UTI) are common. Antibiotic treatment is usually empirical, with the risk of under-treatment of resistant infections. Objectives: To characterise risk factors for antibiotic resistant community urine isolates using routine record linked health data. Methods: Within the National Health Service Scotland Infection Intelligence Platform, national surveillance patient-level data on community urine isolates (January 2012-June 2015) were linked to hospital activity and community prescribing data. Associations between age, gender, comorbidity, care home residence, previous hospitalisations, antibiotic exposure, and resistant (any antibiotic) or MDR (≥1 antibiotic from ≥3 categories) urinary isolates were quantified using multivariable logistic regression.Results: Of 40,984 isolates, 28% were susceptible, 45% resistant, and 27% MDR. Exposure to ≥ 4 different antibiotics in the prior six months increased MDR risk, OR 6.81 (95%CI 5.73-8.11). MDR was associated with ≥29 DDD cumulative exposure, in the prior six months, for any antibiotic (OR 6.54, 95%CI 5.88-7.27), nitrofurantoin (OR 8.56, 95%CI 6.56-11.18) and trimethoprim (OR 14.61, 95%CI10.53-20.27). Associations persisted for 10-12 months for nitrofurantoin (OR 2.31, 95%CI 1.93-2.76) and trimethoprim (OR 1.81, 95%CI 1.57-2.09). Increasing age, comorbidity, previous hospitalisation and care home residence were independently associated with MDR. For resistant isolates the factors were the same but with weaker associations. Conclusion: We have demonstrated, using national capability at scale, the risk of MDR in community urine isolates for the first time and quantified the cumulative and sustained impact of antibiotic exposure. These data will inform the development of decision support tools for UTI treatment.

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