Within-Population Distribution of Trimethoprim Resistance in Escherichia coli before and after a Community-Wide Intervention on Trimethoprim Use

Autor: Martin Sundqvist, Gunnar Kahlmeter, Susanne Granholm, Patrik Rydén, Alma Brolund, Umaer Naseer, Anders Johansson, Arnfinn Sundsfjord
Rok vydání: 2014
Předmět:
Male
Inappropriate Prescribing
Drug resistance
medicine.disease_cause
Trimethoprim
VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Infeksjonsmedisin: 776
Drug Resistance
Multiple
Bacterial
Health care
polycyclic compounds
Pharmacology (medical)
Child
Escherichia coli Infections
Aged
80 and over
education.field_of_study
Chromosome Mapping
Middle Aged
VDP::Medical disciplines: 700::Basic medical
dental and veterinary science disciplines: 710::Medical microbiology: 715
Anti-Bacterial Agents
Infectious Diseases
VDP::Medisinske Fag: 700::Basale medisinske
odontologiske og veterinærmedisinske fag: 710::Medisinsk mikrobiologi: 715
Multigene Family
Female
medicine.drug
Adult
medicine.medical_specialty
Adolescent
Bacteriuria
Population
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Communicable diseases: 776
Biology
Microbiology in the medical area
Microbiology
Mechanisms of Resistance
Intervention (counseling)
Internal medicine
Mikrobiologi inom det medicinska området
Escherichia coli
medicine
Humans
Medical prescription
education
Aged
Sweden
Pharmacology
business.industry
Trimethoprim Resistance
Infant
Newborn
Infant
Epistasis
Genetic
Genes
Bacterial
Folic Acid Antagonists
business
Genome
Bacterial
Multilocus Sequence Typing
Zdroj: Antimicrobial Agents and Chemotherapy. 58:7492-7500
ISSN: 1098-6596
0066-4804
DOI: 10.1128/aac.03228-14
Popis: A 2-year prospective intervention on the prescription of trimethoprim reduced the use by 85% in a health care region with 178,000 inhabitants. Here, we performed before-and-after analyses of the within-population distribution of trimethoprim resistance in Escherichia coli . Phylogenetic and population genetic methods were applied to multilocus sequence typing data of 548 consecutively collected E. coli isolates from clinical urinary specimens. Results were analyzed in relation to antibiotic susceptibility and the presence and genomic location of different trimethoprim resistance gene classes. A total of 163 E. coli sequence types (STs) were identified, of which 68 were previously undescribed. The isolates fell into one of three distinct genetic clusters designated BAPS 1 ( E. coli phylogroup B2), BAPS 2 (phylogroup A and B1), and BAPS 3 (phylogroup D), each with a similar frequency before and after the intervention. BAPS 2 and BAPS 3 were positively and BAPS 1 was negatively associated with trimethoprim resistance (odds ratios of 1.97, 3.17, and 0.26, respectively). In before-and-after analyses, trimethoprim resistance frequency increased in BAPS 1 and decreased in BAPS 2. Resistance to antibiotics other than trimethoprim increased in BAPS 2. Analysis of the genomic location of different trimethoprim resistance genes in isolates of ST69, ST58, and ST73 identified multiple independent acquisition events in isolates of the same ST. The results show that despite a stable overall resistance frequency in E. coli before and after the intervention, marked within-population changes occurred. A decrease of resistance in one major genetic cluster was masked by a reciprocal increase in another major cluster.
Databáze: OpenAIRE
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