Regional Variation in Urinary <i>Escherichia coli</i> Resistance Among Outpatients in Washington State, 2013–2019

Regional Variation in Urinary <i>Escherichia coli</i> Resistance Among Outpatients in Washington State, 2013–2019

<i>Escherichia coli</i> (<i>E. coli</i>) is a predominant pathogen of urinary tract infections (UTIs) in the United States. We analyzed resistance patterns by geographic location in Washington State to assess the need for regional antibiograms. The study included urinary <...

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Bibliographic Details
Main Authors: Hannah T. Fenelon, Stephen E. Hawes, Hema Kapoor, Ann E. Salm, Jeff Radcliff, Peter M. Rabinowitz
Format: Article
Language:English
Published: MDPI AG 2024-11-01
Series:Microorganisms
Subjects:
antimicrobial resistance
<i>E. coli</i>
antibiogram
public health
antimicrobial stewardship
Online Access:https://www.mdpi.com/2076-2607/12/11/2313
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Summary:<i>Escherichia coli</i> (<i>E. coli</i>) is a predominant pathogen of urinary tract infections (UTIs) in the United States. We analyzed resistance patterns by geographic location in Washington State to assess the need for regional antibiograms. The study included urinary <i>E. coli</i> antibiotic susceptibility tests performed by Quest Diagnostics on Washington outpatient isolates from 2013 to 2019. We conducted logistic regressions with robust standard errors for five antibiotics (ceftriaxone, ciprofloxacin, gentamicin, trimethoprim-sulfamethoxazole), with isolates classified as “susceptible” or “resistant” for each antibiotic tested. Analyses were adjusted for sex, year of isolate collection, and age group (0–18, 19–50, >50). The state’s nine Public Health Emergency Preparedness Regions (PHEPRs) were used as the geographic level for the analysis. The analysis included 40,217 isolates (93% from females, mean age 47 years). Compared to the Central PHEPR (containing Seattle), most other regions had significantly lower adjusted prevalence ratios (aPORs) of antimicrobial resistance (AMR), with aPORs as low as 0.20 (95% CI: 0.06–0.63) for ceftriaxone in the North Central region. Additionally, no regions had significantly higher aPOR of resistance for any antibiotic. Differences in resistance between the Central and other regions varied by antibiotic with the largest difference for ceftriaxone and smallest for ampicillin. The finding of regional variation of <i>E. coli</i> AMR calls for more specific community antibiograms to enable a precise approach to antibiotic prescribing and stewardship.
ISSN:2076-2607

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