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Effect of outpatient antibiotics for urinary tract infections on antimicrobial resistance among commensal Enterobacteriaceae: a multinational prospective cohort study

2018; Elsevier BV; Volume: 24; Issue: 9 Linguagem: Inglês

10.1016/j.cmi.2017.12.026

1469-0691

Andrew J. Stewardson, J.J.M. Vervoort, Nele Adriaenssens, Samuel Coenen, Maciek Godycki-Ćwirko, Anna Kowalczyk, Benedikt Huttner, Christine Lammens, Surbhi Malhotra‐Kumar, Herman Goossens, Stephan Harbarth, J.J.M. Vervoort, Christine Lammens, Surbhi Malhotra‐Kumar, Herman Goossens, Niels Adriaenssens, Samuel Coenen, Anna Kowalczyk, Maciek Godycki-Ćwirko, Andrew J. Stewardson, Benedikt Huttner, Stephan Harbarth, Caroline Brossier, Cécile Delémont, Begoña Martínez de Tejada, Gesuèle Renzi, Jacques Schrenzel, Sylvie Van Bylen, Jonathan Vanbergen, Philip Koeck, P. Leysen, Kim Vandercam, J.A.J.W. Kluijtmans, Agnieszka Borkiewicz, Frank Heyvaert, Nele Michels, Gerd Deswaef, Tine Beckx, Hadewijch Declerck, K. Embrechts, N Verheyen, Tine Bauwens, Josefien Béghin, Liesbeth Verpooten, Katrien Bombeke, Tine Vandenabeele, Magdalena Muras, Joanna Świstak, Anna Wesołowska, Ewa Sterniczuk, Lidia Brzozowska, Krystyna Cichowska, Jolanta Szewczyk, Grażyna Krupińska, Honorata Błaszczyk, Urszula Stawińska, Maria Szyler, Marek Kasielski, Rafał Rydz, Agata Myszkowska, Lilianna Żebrowska,

Antibiotic Use and Resistance

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.