Importance
Extended-spectrum β-lactamase (ESBL)–producing
Escherichia coli
is considered a leading pathogen contributing to the global burden of antimicrobial resistance.
Objective
To better ...understand factors associated with the heterogeneity of community-acquired ESBL-producing
E coli
urinary tract infections (UTIs) in France.
Design, Setting, and Participants
This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of
E coli
isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included.
Main Outcomes and Measures
Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing
E coli
strains isolated from urine samples of individuals with community-acquired UTI in 2019.
Results
Among 444 281
E coli
isolates from urine samples tested in 1013 laboratories, the mean prevalence of ESBL-producing
E coli
was 3.0% (range, 1.4%-8.8%). In an adjusted model, the number of community-acquired ESBL-producing
E coli
UTIs in each department was positively associated with the percentage of children younger than 5 years (adjusted β
1
coefficient, 0.112 95% CI, 0.040-0.185;
P
= .004), overcrowded households (adjusted β
1
coefficient, 0.049 95% CI, 0.034 to 0.062;
P
< .001), consumption of fluoroquinolones (adjusted β
1
coefficient, 0.002 95% CI, 0.001-0.002;
P
< .001), and tetracyclines (adjusted β
1
coefficient, 0.0002 0.00004 to 0.00039;
P
= .02), and poultry density (adjusted β
1
coefficient, 0.0001 95% CI, 0.0001-0.0002;
P
< .001). The social deprivation index (adjusted β
1
coefficient, −0.115 95% CI, −0.165 to −0.064;
P
< .001) and the proportion of water surface area (adjusted β
1
coefficient, −0.052 −0.081 to −0.024;
P
= .001) were negatively associated with a higher number of community-acquired ESBL-producing
E coli
UTIs.
Conclusions and Relevance
The findings of this cross-sectional study suggest that multiple human health, animal health, and environmental factors are associated with the occurence of community-acquired ESBL
E coli
UTI. Strategies to mitigate ESBL in the community should follow the One Health approach and address the role played by fluoroquinolones, tetracycline use, poultry density, overcrowded households, and preschool-aged children.
In Europe, the number of cases of Campylobacter enteritis and their quinolone resistance is increasing. The aims of this work were to evaluate: (1) the hospital epidemiology of bacterial enteritis ...between 2010 and 2015. (2) The proportion of Campylobacter and Salmonella enteritis. (3) Resistance to quinolones in adult and paediatric populations. (4) To investigate possible regional epidemiological and bacteriological disparities.
This is a multicentric study carried out in 21 general hospitals (CHG) representing 14 French regions with a prospective collection of the results of coprocultures from 2010 to 2015 in adult and paediatric populations (children < 15 years old not exposed to quinolones). The epidemiological and bacteriological data were collected from software laboratory for positive stool cultures for Campylobacter and Salmonella. The results were compared year by year and by a period of 2 years.
In adults, Campylobacter enteritis was each year significantly more frequent than Salmonella (P < 0.001), with a significant increase from 2010 to 2015 (P < 0.05). In children, there was also a significant and stable predominance of Campylobacter enteritis over the study period (P = 0.002). The quinolone resistance of Campylobacter was greater than 50% on the whole territory, with no North-South difference over the three periods studied. It increased significantly from 2012 to 2015 in adults (48% to 55%, P < 0.05) and in children (54% to 61%, P = 0.04).
Our results confirm the increase in the prevalence of Campylobacter enteritis compared to Salmonella between 2010 and 2015. The quinolone resistance of Campylobacter is greater than 50% on the whole territory, stable between 2010 and 2015 in adults and significantly increased in children.
Full text
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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