Journal Article

Antibiotic prescriptions and risk factors for antimicrobial resistance in patients hospitalized with urinary tract infection: a matched case-control study using the French health insurance database (SNDS)

Brun-Buisson, Christian, Touat, Mehdi, Tuppin, Philippe, Guillemot, Didier, Opatowski, Marion, Watier, Laurence, Salomon, Jérôme

2021

Overview

Background Antibiotic resistance is increasing among urinary pathogens, resulting in worse clinical and economic outcomes. We analysed factors associated with antibiotic-resistant bacteria (ARB) in patients hospitalized for urinary tract infection, using the comprehensive French national claims database. Methods Hospitalized urinary tract infections were identified from 2015 to 2017. Cases (due to ARB) were matched to controls (without ARB) according to year, age, sex, infection, and bacterium. Healthcare-associated (HCAI) and community-acquired (CAI) infections were analysed separately; logistic regressions were stratified by sex. Results From 9460 cases identified, 6468 CAIs and 2855 HCAIs were matched with controls. Over a 12-months window, the risk increased when exposure occurred within the last 3 months. The following risk factors were identified: antibiotic exposure, with an OR reaching 3.6 [2.8–4.5] for men with CAI, mostly associated with broad-spectrum antibiotics; surgical procedure on urinary tract (OR 2.0 [1.5–2.6] for women with HCAI and 1.3 [1.1–1.6] for men with CAI); stay in intensive care unit > 7 days (OR 1.7 [1.2–2.6] for men with HCAI). Studied co-morbidities had no impact on ARB. Conclusions This study points out the critical window of 3 months for antibiotic exposure, confirms the impact of broad-spectrum antibiotic consumption on ARB, and supports the importance of prevention during urological procedures, and long intensive care unit stays.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Administrative claims database / Aged / Aged, 80 and over / Algorithms / Anti-Bacterial Agents / Anti-Bacterial Agents - therapeutic use / Antibiotic resistance / Antibiotics / Antimicrobial agents / Antimicrobial resistance / Bacteria / Care and treatment / Case-Control Studies / Chronic illnesses / Classification / Codes / Collaboration / Consumption data / Demographic aspects / Diabetes / Diagnosis / Dosage and administration / Drug Prescriptions / Drug Prescriptions - statistics & numerical data / Drug resistance / Drug resistance in microorganisms / Drug Resistance, Bacterial / E coli / Economic analysis / Exposure / Female / France / France - epidemiology / Health care / Health insurance / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Human health and pathology / Humans / Infectious Diseases / Insurance, Health / Insurance, Health - statistics & numerical data / Intensive care / Internal Medicine / Laboratories / Life Sciences / Male / Medical Microbiology / Medicine / Medicine & Public Health / Medico-administrative database / Men / Middle Aged / Nosocomial infections / Parasitology / Patients / Resistance factors / Risk analysis / Risk Factors / Risk factors, antibiotic consumption / Sex / SNDS / Tropical Medicine / Urinary tract / Urinary tract diseases / Urinary Tract Infections / Urinary Tract Infections - drug therapy / Urinary Tract Infections - microbiology / Urogenital system / Womens health