Exploring the relationship between primary care antibiotic prescribing for urinary tract infections, Escherichia coli bacteraemia incidence and antimicrobial resistance: an ecological study

Hannah Lishman*, Céire Costelloe, Susan Hopkins, Alan Johnson, Russell Hope, Rebecca Guy, Berit Muller-Pebody, Alison Holmes, Paul Aylin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

This study quantified the association between antibiotic prescribing for urinary tract infections (UTIs) and the incidence/antimicrobial susceptibility of UTI-related Escherichia coli bacteraemia in adult women in England. A national ecological study was conducted with data aggregated at GP practice level. The study population was adult female patients (>18 years) with reported UTI-related E. coli bacteraemia in England (2012–2014). Reports of bacteraemia from the national mandatory surveillance scheme were linked with E. coli blood culture susceptibility data (where available) and the correlation with primary care exposure to trimethoprim and nitrofurantoin was quantified using longitudinal multilevel models. The study included 19 874 patients from 5916 practices. The overall incidence of UTI-related E. coli bacteraemia in the study group did not change significantly (1.3% increase, 95% CI 0.1–2.7%; P = 0.074). However, after adjusting for practice characteristics, UTI-related E. coli bacteraemia incidence increased by 3.0% (P < 0.001) and 1.5% (P < 0.01) with each increasing quintile in trimethoprim and nitrofurantoin prescribing, respectively. The incidence of trimethoprim-resistant bacteraemia increased by 4.5% (P = 0.032) with each increasing quintile in trimethoprim prescribing and was not associated with nitrofurantoin prescribing. This study demonstrated an association between GP prescribing for UTIs and UTI-related E. coli bacteraemia incidence at the practice level and showed that higher prescribing of trimethoprim is associated with higher incidence of trimethoprim-resistant bacteraemia. Evidence is provided of the importance of prudent antibiotic prescribing in primary care to prevent the development of antibiotic resistance, placing patients at risk of subsequent severe infections.

Original languageEnglish
Pages (from-to)790-798
Number of pages9
JournalInternational Journal of Antimicrobial Agents
Volume52
Issue number6
DOIs
Publication statusPublished - Dec 2018

Bibliographical note

Funding Information:
PA reports grants from the National Institute for Health Research (NIHR) and grants from Dr Foster Intelligence during the conduct of the study. All other authors declare no competing interests.

Funding Information:
The authors would like to thank Mehdi Minaji, Miroslava Mihalkova and Sabine Bou-Antoun for their assistance with data extraction from the PHE infection-related databases. This work was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) [grant no. HPRU-2012-10047] in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London (London, UK) in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR, the Department of Health, or PHE. PA reports grants from the National Institute for Health Research (NIHR) and grants from Dr Foster Intelligence during the conduct of the study. All other authors declare no competing interests. Not required.

Funding Information:
This work was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) [grant no. HPRU-2012-10047] in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London (London, UK) in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR, the Department of Health, or PHE.

Publisher Copyright:
© 2018

Keywords

  • Antimicrobial resistance
  • Epidemiology
  • Escherichia coli bacteraemia
  • Primary care
  • UTI
  • Urinary tract infection

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