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)

Abstract

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.

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“…Research in hospitals has consistently identified positive associations between antibiotic use and infection or colonization with MDR bacteria [8] , [9] , [10] . Additional correlates of MDR infection or colonization within clinical settings include measures of health care exposure such as invasive procedures, use of catheters or intubation [11] , [12] , [13] , previous hospitalization [14] , [15] , [16] , and length of hospital stay [ 9 , 17 ]. However, more studies have examined the risk factors associated with infection without considering colonization with MDR organisms as an end point of interest, and most of these studies have been carried out in high-income settings.…”