Trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in community settings: the Vigil'Roc multicenter studies

Abstract

Objective This study was performed in order to describe the trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in community settings. Material and methods In 1993, 1997 and 2000, 9,290 strains of Enterobacteriaceae were isolated in community lab settings and their susceptibility to antibiotics evaluated by the disk method according to French recommendations (CA-SFM). Epidemiological data concerning the medical history of patients was simultaneously collected. Results Samples were mostly from the urinary tract (88.7%) and women (79.5%). 88.2% of the strains were Escherichia coli and Proteus mirabilis. Over the three studies, we noted an increasing resistance to penicillins, coamoxiclav, and cotrimoxazole for E. coli, to coamoxiclav for P. mirabilis, and to penicillins for Salmonella sp. Ceftriaxone, gentamicin, and ciprofloxacin remained very active. Producers of extended-spectrum β-lactamase were detected for a rising number of species, but strains remained rare (0.5%). The analysis, by logistic regression, of the risk factors for adults to be infected by a resistant strain of E. coli, lead to observe a narrow association of antimicrobial resistance with prior antibiotherapy, and a relative specificity between the family of prior antibiotics and the compound affected by bacterial resistance. Prior hospitalization was preferentially linked to multiresistance and age > 60 years was associated with cefixime and quinolone resistance and with multiresistance. Resistance of E. coli to penicillins was more elevated in children than in adults, and was also linked to a prior antibiotic use by children. Some comparable results were obtained through a univariate analysis for P. mirabilis and Salmonella sp.