Increasing community prevalence of extended-spectrum beta-lactamase-producing Escherichia coli in urine is associated with increasing district-level antibiotic consumption

• Published in: FEMS microbiology letters Vol. 371
• Main Authors: Nunes, Larissa Hermann de Souza, Ribeiro, Victoria Stadler Tasca, Salviato, Rafael Buttini, de Andrade, Ana Paula, Suss, Paula Hansen, Vicenzi, Fernando José, Hino, Adriano Akira Ferreira, Telles, João Paulo, Tuon, Felipe Francisco
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 09.01.2024
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; beta-Lactamases - metabolism; Brazil - epidemiology; Child; Child, Preschool; Escherichia coli - drug effects; Escherichia coli - enzymology; Escherichia coli - isolation & purification; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Escherichia coli Infections - urine; Female; Humans; Infant; Longitudinal Studies; Male; Microbial Sensitivity Tests; Middle Aged; Prevalence; Urinary Tract Infections - drug therapy; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Young Adult; Brazil; extended-spectrum beta-lactamases; beta-lactamases; drug resistance; public health; Escherichia coli
• ISSN: 1574-6968; 1574-6968
• DOI: 10.1093/femsle/fnae038

Abstract This study aimed to analyze ESBL-producing Escherichia coli prevalence in urine samples collected between 2011–2019 in Curitiba, a large city in Brazil, and relating it to antibiotic consumption and sanitary conditions. This is a longitudinal study correlating prevalence of ESBL-producing E. coli isolates from urine samples with district-level antibiotic consumption and sociodemographic data during 2011–2019. E. coli isolates were tested for antibiotic susceptibility and ESBL by an automated method. Statistical analysis applied linear regressions, pooled ordinary least squares, and fixed effects models for districts or years. The Chow and Hausman tests indicated that the fixed effects model for individual districts fitted best. Chi-square test was used for qualitative variables (statistical significance was set when P < 0.05). Among the 886 535 urine sample cultures, 9.9% of isolates were ESBL-producing E. coli. Their prevalence increased from 4.7% in 2012 to 19.3% in 2019 (P < 0.0001; R2 = 0.922). This progressive increase correlated with age (P = 0.007; R2 = 0.8725) and male gender (P < 0.001) and increased antibiotic consumption (P = 0.0386; R2 = 0.47). The fixed effects model showed that district influences ESBL prevalence and that antibiotic consumption explains 20%–30% of this variation, with an increase of one defined daily dose accounting for an increase of 0.02084 percentage points of ESBL. The increasing prevalence of ESBL-producing E. coli can, to a considerable extent, be explained by increasing antibiotic consumption. Increased antibiotic consumption between 2011 and 2019 was associated with increased prevalence of ESBL-producing E. coli in urine samples.