TY - JOUR
T1 - Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands
AU - Honsbeek, Maaike
AU - Tjon-A-Tsien, Aimee
AU - Stobberingh, Ellen
AU - de Steenwinkel, Jurriaan
AU - Melles, Damian C.
AU - Lous, Jan
AU - Richardus, Jan Hendrik
AU - Voeten, Helene
N1 - Funding Information:
We would like to thank Gerard van Asselt of Star-SHL and Timo Boelsums of the Municipal Public Health Service Hollands Midden for their advice.
Funding Information:
This work was supported by the National Institute for Public Health and the Environment (RIVM), the Netherlands and The Netherlands Organization for Scientific Research (NWO), the Netherlands (grant number 023.010.001). These grants were used for the design of the study, analysis, interpretation of data and in writing the manuscript.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/1/6
Y1 - 2020/1/6
N2 - Antimicrobial resistance (AMR) is an increasing problem. The prevalence of antimicrobial resistance in general practice patients is expected to be relatively high in Rotterdam, the Dutch city with the largest proportion non-Western immigrants. The aim of this study was to assess the prevalence of antibiotic-resistant uropathogens (Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis) in general practices in Rotterdam, and to find a possible association between the prevalence of antibiotic-resistant E. coli and age, gender, and socioeconomic status (SES). A retrospective analysis was performed of urine samples from general practice patients in 2016. The prevalence of AMR in uropathogens was compared with national resistance data, as was the prevalence of highly and multidrug resistant and extended spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae. Univariate logistic regression was used to study associations between antibiotic-resistant E. coli and age, gender, and SES area score. No clinically relevant differences were observed in the prevalence of antibiotic-resistant uropathogens in Rotterdam compared with the national prevalence. For E. coli and K. pneumoniae, the prevalence was 3.6% for ESBL production (both pathogens together), while the prevalence ranged between 4.2%-5.0% for high resistance and between 1.2%-3.3% for multidrug resistance. Ciprofloxacin-resistant E. coli was significantly associated with higher age. Although Rotterdam has a high percentage of non-western immigrants and a low SES, AMR is low among general practice patients. This indicates that adherence to national guidelines in general practice enables maintenance of low AMR, even in high-risk populations.
AB - Antimicrobial resistance (AMR) is an increasing problem. The prevalence of antimicrobial resistance in general practice patients is expected to be relatively high in Rotterdam, the Dutch city with the largest proportion non-Western immigrants. The aim of this study was to assess the prevalence of antibiotic-resistant uropathogens (Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis) in general practices in Rotterdam, and to find a possible association between the prevalence of antibiotic-resistant E. coli and age, gender, and socioeconomic status (SES). A retrospective analysis was performed of urine samples from general practice patients in 2016. The prevalence of AMR in uropathogens was compared with national resistance data, as was the prevalence of highly and multidrug resistant and extended spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae. Univariate logistic regression was used to study associations between antibiotic-resistant E. coli and age, gender, and SES area score. No clinically relevant differences were observed in the prevalence of antibiotic-resistant uropathogens in Rotterdam compared with the national prevalence. For E. coli and K. pneumoniae, the prevalence was 3.6% for ESBL production (both pathogens together), while the prevalence ranged between 4.2%-5.0% for high resistance and between 1.2%-3.3% for multidrug resistance. Ciprofloxacin-resistant E. coli was significantly associated with higher age. Although Rotterdam has a high percentage of non-western immigrants and a low SES, AMR is low among general practice patients. This indicates that adherence to national guidelines in general practice enables maintenance of low AMR, even in high-risk populations.
KW - Antimicrobial resistance
KW - Prevalence
KW - General practice
KW - LACTAMASE-PRODUCING ENTEROBACTERIACEAE
KW - ESBL-PRODUCING ENTEROBACTERIACEAE
KW - URINARY-TRACT-INFECTIONS
KW - EXTENDED-SPECTRUM
KW - RISK-FACTORS
KW - ESCHERICHIA-COLI
KW - PREVALENCE
KW - CARRIAGE
KW - COMMUNITY
KW - TRAVELERS
U2 - 10.1007/s10096-019-03804-8
DO - 10.1007/s10096-019-03804-8
M3 - Article
C2 - 31907762
SN - 0934-9723
VL - 39
SP - 929
EP - 935
JO - European Journal of Clinical Microbiology & Infectious Diseases
JF - European Journal of Clinical Microbiology & Infectious Diseases
IS - 5
ER -