Surveillance of antibiotic susceptibility of urinary tract pathogens for a population of 5.6 million over 4 years.
OBJECTIVE
To retrospectively analyse routine susceptibility testing data to describe antimicrobial non-susceptibility trends in isolates of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa from urine samples in a population of 5.6 million people over a 4 year period.


METHODS
De-duplicated laboratory data submitted to the AmSurv surveillance system from the West Midlands region of England and results of submissions to the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit were extracted for the period 2010-13. Descriptive analysis of the non-susceptibility of selected Gram-negative organisms to key antibiotics, as recommended for monitoring in the UK Five Year Antimicrobial Resistance Strategy, was undertaken.


RESULTS
During the study period, there were 431 461 reports for E. coli, 23 786 for K. pneumoniae and 6985 for P. aeruginosa from urine specimens. These represented 61%, 3% and 1%, respectively, of all organisms isolated from urine specimens. There was a linear increase in non-susceptibility to third-generation cephalosporins for E. coli and K. pneumoniae, and to ciprofloxacin for E. coli, in specimens from both hospital and community settings (P < 0.001). The proportions of E. coli and K. pneumoniae reported non-susceptible to meropenem and/or imipenem remained low during the study period, with no evidence of linear trend (P ≥ 0.05).


CONCLUSIONS
Automated antimicrobial resistance surveillance enabled, for the first time in England, the systematic monitoring of resistance in bacteria responsible for urinary tract infections in a defined population, and thereby provided a representative indication of the burden of resistance in Gram-negative bacteria in hospital and community settings.
Field Epidemiology Service, Public Health England, Birmingham, UK dean.ironmonger@phe.gov.uk.
Dean
D
Ironmonger
Field Epidemiology Service, Public Health England, Birmingham, UK.
Obaghe
O
Edeghere
Field Epidemiology Service, Public Health England, Birmingham, UK.
Amardeep
A
Bains
Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, UK.
Richard
R
Loy
Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, UK.
Neil
N
Woodford
Public Health Laboratory, Public Health England, Heart of England NHS Foundation Trust, Birmingham, UK Institute of Microbiology and Infection, Biosciences, University of Birmingham, Birmingham, UK.
Peter M
PM
Hawkey
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004739:England / Q000453:epidemiology; D062665:Epidemiological Monitoring; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*
D000900:Anti-Bacterial Agents
Gram-negative; UTIs; antibiotic resistance; epidemiology; microbiology