Susceptibility patterns and ESBL rates of Escherichia coli from urinary tract infections in Canada and the United States, SMART 2010-2014.
Increasing antimicrobial resistance in urinary tract infections (UTI) is a concern. To evaluate resistance trends, 3498 Escherichia coli UTI isolates were collected from 2010 to 2014 in the Study for Monitoring Antimicrobial Resistance Trends (SMART) in Canada and United States (US). ESBL phenotype and susceptibility were determined using CLSI microdilution and breakpoints. US ESBL rates increased in 2010-2014 (7.8-18.3%, P < 0.0001), especially among hospital-associated (HA) infections, males, and older patients (≥65 years). Overall, ESBL rates in Canada showed no significant trend (10.4-13.0%. P = 0.079), and were lower than US rates in recent years, but increased significantly among community-associated (CA) infections, females, and older patients. In the US, but not Canada, susceptibility to cephalosporins and fluoroquinolones among 2013-2014 isolates was significantly lower in isolates from HA than CA UTI, males than females, and ≥65- than <65-year-olds. These observations confirm increasing resistance in E. coli. Subgroup analyses like these may help direct empirical therapy.
International Health Management Associates, Inc., Schaumburg, IL, USA. Electronic address: shlob@ihmainc.com.
Sibylle H
SH
Lob
Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, School of Medicine, University of Manitoba, Winnipeg, Canada.
Lindsay E
LE
Nicolle
International Health Management Associates, Inc., Schaumburg, IL, USA.
Daryl J
DJ
Hoban
International Health Management Associates, Inc., Schaumburg, IL, USA.
Krystyna M
KM
Kazmierczak
International Health Management Associates, Inc., Schaumburg, IL, USA.
Robert E
RE
Badal
International Health Management Associates, Inc., Schaumburg, IL, USA.
Daniel F
DF
Sahm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002170:Canada / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D001618:beta-Lactamases / Q000032:analysis*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D001618:beta-Lactamases
Canada; ESBL; Escherichia coli; SMART; Susceptibility; United States; Urinary tract infection