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Watts V, Brown B, Ahmed M, Charlett A, Chew-Graham C, Cleary P, Decraene V, Dodgson K, George R, Hopkins S, Esmail A, Welfare W. Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England. JAC Antimicrob Resist 2020; 2:dlaa022. [PMID: 34222986 PMCID: PMC8210191 DOI: 10.1093/jacamr/dlaa022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data. Methods All patients aged ≥18 years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of Escherichia coli isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates. Results Sentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21-35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were E. coli (113/169). Non-susceptibility of E. coli to trimethoprim was 28.2% (95% CI 20.2-37.7) on sentinel surveillance (33.4%; 95% CI 29.5-37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0-5.7) (1.5%; 95% CI 0.7-3.0 on routine data). Conclusions Routine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.
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Affiliation(s)
- Vicky Watts
- Field Service North West, National Infection Service, Public Health England, Liverpool, UK
| | - Benjamin Brown
- Centre for Primary Care, Division of Population Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Maria Ahmed
- Manchester Medical, Moss Side Health Centre, Manchester, UK.,NIHR Clinical Research Network: Greater Manchester, Manchester, UK
| | - André Charlett
- Statistics Unit, Data and Analytical Sciences, National Infection Service, Public Health England, London, UK
| | - Carolyn Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Paul Cleary
- Field Service North West, National Infection Service, Public Health England, Liverpool, UK
| | - Valerie Decraene
- Field Service North West, National Infection Service, Public Health England, Liverpool, UK
| | - Kirsty Dodgson
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Ryan George
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Susan Hopkins
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK
| | - Aneez Esmail
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - William Welfare
- Health Protection Team, Public Health England North West, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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