Abstract
Objective
To better understand the epidemiology of drug-resistant Escherichia coli across health care and community settings.
Patients and Methods
We conducted a population-based cohort study of the incidence of antibiotic-resistant
E coli bacteriuria among different patient groups. All urine cultures with monomicrobial
growth of E coli obtained from Olmsted County, Minnesota, residents from January 1, 2005, through
December 31, 2009, were identified. The initial isolate per patient per year was included.
Analyses were stratified by patient age and location of infection onset (ie, nosocomial,
health care associated, and community associated).
Results
We evaluated 5619 E coli isolates and the associated patients. During the study period, the incidence of drug-resistant
bacteriuria did not change among children but increased significantly among adults
of all ages, most markedly among elderly patients older than 80 years. In elderly
patients, the incidence of bacteriuria with isolates resistant to fluoroquinolones
increased from 464 to 1116 per 100,000 person-years (P<.001), and the incidence of bacteriuria with isolates resistant to fluoroquinolones
plus trimethoprim-sulfamethoxazole increased from 274 to 512 per 100,000 person-years
(P<.05). When analyzed by location of infection onset, incidence of bacteriuria with
isolates resistant to trimethoprim-sulfamethoxazole, fluoroquinolones, trimethoprim-sulfamethoxazole
plus fluoroquinolones, extended-spectrum cephalosporins, and more than 3 drug classes
increased significantly among community-associated but not among nosocomial or health
care–associated cases.
Conclusion
In this population-based study, the incidence of antibiotic-resistant E coli bacteriuria nearly doubled during the 5-year study period among elderly patients
and those with community-associated isolates. These patient groups should be targets
of interventions to slow the emergence and spread of antibiotic-resistant E coli.
Abbreviations and Acronyms:
CA (community associated), HA (health care associated), UTI (urinary tract infection)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: July 16, 2012
Footnotes
Grant Support: This work was supported by funds from the Departments of Medicine and Pediatric and Adolescent Medicine, Mayo Clinic , and National Institute of Health grant RO1 AG034676 , the Rochester Epidemiology Project (Dr Walter A. Rocca, principal investigator).
Identification
Copyright
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
