title: Living conditions are associated with increased antibiotic resistance in community isolates of Escherichia coli.
abstract: OBJECTIVE
  The objective of this study was to measure the associations between domains of deprivation and antibiotic resistance of Escherichia coli.
  
  
  METHODS
  Routine surveillance data for antibiotic susceptibility of E. coli isolates were obtained from urine specimens taken from patients presenting with suspected urinary tract infection in 2010-12 to healthcare practitioners based in the community in Leeds and Bradford. Eight antibiotics were included in the analyses. Postcodes were linked to lower super output areas (average populations of 1500). The 2010 Indices of Deprivation were used as neighbourhood characteristics for each lower super output area. Multilevel logistic regression models were used to estimate the independent effect of structural components on the odds of resistance to each antibiotic.
  
  
  RESULTS
  With respect to living conditions, residence in the most-deprived areas compared with the least-deprived areas was associated with increased odds of antibiotic resistance for all eight antibiotics analysed. The magnitude of these associations included an OR of 2.04 (95% CI 1.03-3.07) for cefalexin, 2.16 (95% CI 1.16-4.05) for ciprofloxacin, 2.47 (95% CI 1.08-5.66) for nitrofurantoin and 1.33 (95% CI 1.07-1.75) for trimethoprim.
  
  
  CONCLUSIONS
  Social deprivation in the form of living conditions is associated with increased antibiotic resistance for E. coli. This evidence suggests there is a need for further individual-level studies to explore the potential mechanism for these associations.
authors.affiliation: Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Brenda O
authors.initials: BO
authors.lastname: Nomamiukor
authors.affiliation: Old Medical School, Leeds General Infirmary, Public Health England - Leeds, Leeds, UK.
authors.forename: Carolyne
authors.initials: C
authors.lastname: Horner
authors.affiliation: Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK a.kirby@leeds.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirby
authors.affiliation: Academic Unit of Public Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012924:Social Conditions; D012959:Socioeconomic Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D014556:Urine / Q000382:microbiology; D055815:Young Adult