A study conducted in France suggests that human, animal and environmental exposures may all be linked to the occurrence of community-acquired and multidrug-resistant urinary tract infections (UTIs).
Findings on urinary tract infections caused by the production of extended-spectrum beta-lactamases (ESBL) Escherichia coli were reported yesterday in JAMA network open.
Although these multidrug-resistant UTIs have long been a problem in hospitals and other healthcare settings where patients are routinely exposed to bacterial pathogens and antibiotics, the incidence of community-acquired ESBLs E-coli UTIs have increased in recent years, with a variety of factors cited as potential culprits. ESBL producers E-coli is considered a growing threat to public health because the ESBL enzyme confers resistance to several classes of antibiotics and makes common infections like UTIs difficult to treat.
The study authors say the findings underscore the importance of monitoring and mitigation strategies that take a One Health approach.
Multiple Cited Exhibitions
For the cross-sectional study, the researchers used retrospective epidemiological and microbiological data collected in 2019 through PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a national clinical laboratory surveillance system for administrative services in France. Isolates, which were obtained from community urine specimens positive for E-coliwere tested for antimicrobial susceptibility and ESBL production.
Quasi-Poisson regression models were used to assess associations between several ecological factors available at government and administrative sites and the number of ESBL producers. E-coli isolated from people with community-acquired urinary tract infections. Among the factors assessed were population demographic structure, living conditions, basic health services, antibiotic consumption, stocking density and environmental characteristics.
Among community urine samples from 59 French departments, 444,281 E-coli isolates and 13,352 ESBL producers E-coli strains have been identified, for an overall ESBL prevalence rate of 3.0% E-coli. In multivariate analysis, consumption of fluoroquinolones (adjusted beta coefficient, .002) and tetracyclines (adjusted beta coefficient, .0002), local percentage of children under 5 (adjusted beta coefficient, .112), households overcrowding (adjusted beta coefficient, 0.049) and poultry density (adjusted beta coefficient, 0.0001) were positively associated with ESBL production. E-coli UTI.
Some of these factors, such as the use of fluoroquinolones, have already been associated with an increased risk of ESBL production E-coli colonization or infection. “The positive association of ESBL producers of Community origin E-coli Fluoroquinolone urinary tract infections confirm the importance of efforts to reduce their consumption,” the study authors wrote.
They also note that previous research has suggested household overcrowding may play a role in the spread of ESBL-producing bacteria. E-coli due to the proximity of contacts and multiple opportunities for transmission. Additionally, members of households with preschool children are at increased risk of intestinal carriage of ESBL-producing bacteria. And several studies have documented the presence of ESBL-producing bacteria E-coli in retail chicken meat.
But other discoveries were more surprising. The association with tetracycline consumption was unexpected, the authors said, and it underscores the need for greater management of tetracyclines, which are the third most consumed class of antibiotics in French primary care.
“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 children” , the authors concluded.
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