Antimicrobial Resistance in More than 100,000 Escherichia coli Isolates According to Culture Site and Patient Age, Gender, and Location

Abstract

Escherichia coli and the antimicrobial pressure exerted on this microorganism can be modulated by factors dependent on the host. In this paper, we describe the distribution of antimicrobial resistance to amikacin, tobramycin, ampicillin, amoxicillin clavulanate, cefuroxime, cefoxitin, cefotaxime, imipenem, ciprofloxacin, fosfomycin, nitrofurantoin, and trimetoprim-sulfametoxazole in more than 100,000 E. coli isolates according to culture site and patient age, gender, and location. Bayesian inference was planned in all statistical analysis, and Markov chain Monte Carlo simulation was employed to estimate the model parameters. Our findings show the existence of a marked difference in the susceptibility to several antimicrobial agents depending on from where E. coli was isolated, with higher levels of resistance in isolates from medical devices, the respiratory system, and the skin and soft tissues; a higher resistance percentage in men than in women; and the existence of a clear difference in antimicrobial resistance with an age influence that cannot be explained merely by means of an increase of resistance after exposure to antimicrobials. Both men and women show increases in resistance with age, but while women show constant levels of resistance or slight increases during childbearing age and greater increases in the premenopausal age, men show a marked increase in resistance in the pubertal age. In conclusion, an overwhelming amount of data reveals the great adaptation capacity of E. coli and its close interaction with the host. Sex, age, and the origin of infection are determining factors with the ability to modulate antimicrobial resistances.

Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia

“…According to our results, not one agent could be declared fit for empiric use in elderly patients. Our findings are in accordance with numerous studies which also encountered high resistance rates among older age groups [24][25][26][27].…”

“…Results from different studies confirm our findings that resistance rates were higher in male patients than in female [27,30]. In fact, certain studies imply that empiric therapy for genders should be established through gender-stratified surveillance studies [30].…”

“…Guidelines state that if resistance to an antimicrobial agent exceeds the 20% threshold, it should no longer be recommended for empiric therapy [5,13,23]. Resistance rates among different age groups were observed to increase as the age of the patient increased, which supports claims from other studies [24][25][26][27]. Pathogens isolated from patients within the age group 18-34 years showed low rates of resistance to several antimicrobial agents (<10%), most notably to amikacin (4.2%), ceftriaxone (7.7%), cefepime (8.0%), and norfloxacin (10.0%), which implies that these agents should be used as firstline therapy for this age group in our population.…”

Antimicrobial Susceptibility ofEscherichia coliin Uncomplicated Cystitis in the Emergency Department: Is the Hospital Antibiogram an Effective Treatment Guide?

“…4 Furthermore, aggregated culture results for E. coli will include samples cultured from nonurine sources, which are more likely to yield resistant isolates. 5 We hypothesized that an antibiogram aggregated from hospital-wide E. coli isolates overestimates the resistance profile of E. coli in acute cystitis cases presenting to the ED.…”

“…2 Escherichia coli is the most commonly implicated pathogen, 3 although there are variable local patterns of resistance to common antimicrobial agents such as trimethoprim-sulfamethoxazole (TMP-SMX) and ciprofloxacin. [4][5][6] The hospital antibiogram is a tool designed specifically to guide clinical decisions in the face of changing bacterial resistance to drug therapy. It is generally compiled annually and is based on information aggregated from that institution's cultured isolates.…”