Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England

Watts, Vicky; Brown, Benjamin; Ahmed, Maria; Charlett, Andre; Chew-Graham, Carolyn; Cleary, Paul; Decraene, Valerie; Dodgson, Kirsty; George, Ryan; Hopkins, Susan; Esmail, Aneez; Welfare, William

Abstract

Objectives
To assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data.

Methods
All patients aged ≥18 years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of Escherichia coli isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates.

Results
Sentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21–35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were E. coli (113/169). Non-susceptibility of E. coli to trimethoprim was 28.2% (95% CI 20.2–37.7) on sentinel surveillance (33.4%; 95% CI 29.5–37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0–5.7) (1.5%; 95% CI 0.7–3.0 on routine data).

Conclusions
Routine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.

Citation

Watts, V., Brown, B., Ahmed, M., Charlett, A., Chew-Graham, C., Cleary, P., …Welfare, W. (2020). Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England. JAC-ANTIMICROBIAL RESISTANCE, 2(2), Article ARTN dlaa022. https://doi.org/10.1093/jacamr/dlaa022

• Journal Article Type: Article
• Acceptance Date: Feb 20, 2020
• Online Publication Date: May 27, 2020
• Publication Date: 2020-06
• Deposit Date: Jun 27, 2023
• Journal: JAC-ANTIMICROBIAL RESISTANCE
• Peer Reviewed: Peer Reviewed
• Volume: 2
• Issue: 2
• Article Number: ARTN dlaa022
• DOI: https://doi.org/10.1093/jacamr/dlaa022
• Keywords: cephalexin; ciprofloxacin; urinary tract infections; amoxicillin-potassium clavulanate combination; drug resistance, microbial; nitrofurantoin; sentinel surveillance; trimethoprim; guidelines; antimicrobials; antimicrobial susceptibility; surveillance, me