Assessment of Factors Associated With Community-Acquired Extended-Spectrum β-Lactamase–Producing <i>Escherichia coli</i> Urinary Tract Infections in France
Adeline Paumier, Antoine Asquier-Khati, S. Thibaut, T. Coëffic, Olivier Lemenand, Stéphanie Larramendy, Brice Leclère, J. Caillon, David Boutoille, Gabriel Birgand, Sophie Poyet, Guillaume Deléglise, Lydie Libier, Simon Benzimra, Denis Laforest, Laurent Clotteau, Karine Michez, Marie-Jeanne Blanc-Galiby, Franck Kerdavid, Brigitte Coude Du Foresto, François Maillet, Hubert Banctel, Jean Lacroze, Marie-pierre Thibault, Eric Grandsire, Pierre-Yves Léonard, Jean-François Culard, Anne Holstein, Beatrice Dubet, Sébastien Fougnot, Bruno Guesnon, Anne-Sophie Reinhard, Jean Philippe Rault, B Gestin, Jerome Fleurance, Alisson Vrain, Philippe Andorin, Géoffroy De Gastines, Christine Fantinato, Vidal Plong, Nicolas Le Moing, Emilie Pradier, Regis Gouarin, Didier Grisard, Stéphanie Arsene, Elodie Jobert, Charles Veron, Gérard Payro, Annie Allery, Helene Valade, Delphine Boraud, Remi Gebeile, E Parisi, Francoise Alluin, Caroline Coulon, Guillaume Teissier, Arnaud François, Gilles Defrance, Gisele Gay, Olivier Duquesnoy, Fabienne Artur, Sylvain Millet, Pierre Marchenay, Norbert Desbiolles, Marie Carole Paolini, Eugénie Mbenga, Arel Desjardins, Christian Ehret
Abstract
Importance: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is considered a leading pathogen contributing to the global burden of antimicrobial resistance. Objective: To better understand factors associated with the heterogeneity of community-acquired ESBL-producing E coli urinary tract infections (UTIs) in France. Design, Setting, and Participants: This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of E coli isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included. Main Outcomes and Measures: Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing E coli strains isolated from urine samples of individuals with community-acquired UTI in 2019. Results: Among 444 281 E coli isolates from urine samples tested in 1013 laboratories, the mean prevalence of ESBL-producing E coli was 3.0% (range, 1.4%-8.8%). In an adjusted model, the number of community-acquired ESBL-producing E coli UTIs in each department was positively associated with the percentage of children younger than 5 years (adjusted β1 coefficient, 0.112 [95% CI, 0.040-0.185]; P = .004), overcrowded households (adjusted β1 coefficient, 0.049 [95% CI, 0.034 to 0.062]; P < .001), consumption of fluoroquinolones (adjusted β1 coefficient, 0.002 [95% CI, 0.001-0.002]; P < .001), and tetracyclines (adjusted β1 coefficient, 0.0002 [0.00004 to 0.00039]; P = .02), and poultry density (adjusted β1 coefficient, 0.0001 [95% CI, 0.0001-0.0002]; P < .001). The social deprivation index (adjusted β1 coefficient, -0.115 [95% CI, -0.165 to -0.064]; P < .001) and the proportion of water surface area (adjusted β1 coefficient, -0.052 [-0.081 to -0.024]; P = .001) were negatively associated with a higher number of community-acquired ESBL-producing E coli UTIs. Conclusions and Relevance: The findings of this cross-sectional study suggest that multiple human health, animal health, and environmental factors are associated with the occurence of community-acquired ESBL E coli UTI. Strategies to mitigate ESBL in the community should follow the One Health approach and address the role played by fluoroquinolones, tetracycline use, poultry density, overcrowded households, and preschool-aged children.