Background
Methods
Study design
Outcomes
Statistical analysis
Results
Resistance by drug class
Organism | Antimicrobial resistance | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ESBL phenotype | Beta-lactam | Trimethoprim/sulfamethoxazole | Fluoroquinolones | Nitrofurantoin | |||||||||||
Tested | NS | % NS | Tested | NS | % NS | Tested | NS | % NS | Tested | NS | % NS | Tested | NS | % NS | |
All | 2,095,447 | 145,448 | 6.9 | 2,228,515 | 1,280,780 | 57.5 | 2,228,515 | 513,945 | 23.1 | 2,228,515 | 459,339 | 20.6 | 2,228,515 | 450,818 | 20.2 |
E. coli | 1,623,448 | 116,843 | 7.2 | 1,623,448 | 817,083 | 50.3 | 1,623,448 | 422,699 | 26.0 | 1,623,448 | 376,459 | 23.2 | 1,623,448 | 64,194 | 4.0 |
K. pneumoniae | 301,628 | 17,359 | 5.8 | 301,628 | 274,284 | 90.9 | 301,628 | 33,231 | 11.0 | 301,628 | 18,003 | 6.0 | 301,628 | 174,453 | 57.8 |
P. mirabilis | 139,204 | 8991 | 6.5 | 139,204 | 38,423 | 27.6 | 139,204 | 36,105 | 25.9 | 139,204 | 43,767 | 31.4 | 139,204 | 124,276 | 89.3 |
E. cloacae | 39,007 | 35,090 | 90.0 | 39,007 | 5442 | 14.0 | 39,007 | 3110 | 8.0 | 39,007 | 25,143 | 64.5 | |||
K. oxytoca | 31,167 | 2255 | 7.2 | 31,167 | 29,636 | 95.1 | 31,167 | 2939 | 9.4 | 31,167 | 1715 | 5.5 | 31,167 | 5010 | 16.1 |
K. aerogenes | 30,234 | 26,770 | 88.5 | 30,234 | 836 | 2.8 | 30,234 | 889 | 2.9 | 30,234 | 23,851 | 78.9 | |||
C. freundii | 28,300 | 25,808 | 91.2 | 28,300 | 4475 | 15.8 | 28,300 | 2668 | 9.4 | 28,300 | 2012 | 7.1 | |||
M. morganii | 16,162 | 15,585 | 96.4 | 16,162 | 5609 | 34.7 | 16,162 | 5799 | 35.9 | 16,162 | 14,296 | 88.5 | |||
P. stuartii | 7916 | 7675 | 97.0 | 7916 | 2272 | 28.7 | 7916 | 5957 | 75.3 | 7916 | 6984 | 88.2 | |||
S. marcsescens | 11,449 | 10,426 | 91.1 | 11,449 | 337 | 2.9 | 11,449 | 972 | 8.5 | 11,449 | 10,599 | 92.6 |
ESBL resistance profile | n | Resistance to additional antimicrobials n (%) | |||
---|---|---|---|---|---|
FQ | TMP/SMX | NFT | Beta-lactams | ||
ESBL only | 145,448 (100%) | 101,971 (70.1%) | 87,145 (59.9%) | 48,470 (33.5%) | 134,038 (92.2%) |
ESBL + FQ | 101,971 (100%) | 73,363 (71.9%) | 38,372 (37.6%) | 101,222 (99.3%) | |
ESBL + TMP/SMX | 87,145 (100%) | 73,363 (84.2%) | 35,619 (40.9%) | 86,738 (99.5%) | |
ESBL + NFT | 48,740 (100%) | 38,372 (78.7%) | 35,619 (73.1%) | 48,497 (99.5%) | |
ESBL + FQ + TMP/SMX | 73,363 (100%) | 30,784 (42.0%) | 73,030 (99.5%) | ||
ESBL + FQ + TMP/SMX + NFT | 30,784 (100%) | 30,698 (99.7%) |
Trends in antibiotic-resistant urinary Enterobacterales over time
Characteristics | ESBL | Beta-lactam | Trimethoprim/sulfamethoxazole | Fluoroquinolone | Nitrofurantoin | |||||
---|---|---|---|---|---|---|---|---|---|---|
Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | |
Year | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 | |||||
2011 | 6.5 (6.3–6.8) | 60.5 (60.2–60.9) | 25.7 (25.1–26.2) | 25.6 (25.0–26.2) | 21.6 (21.1–22.4) | |||||
2012 | 6.8 (6.5–7.0) | 59.9 (59.5–60.3) | 26.5 (25.9–27.0) | 25.0 (24.4–25.5) | 23.1 (22.5–23.9) | |||||
2013 | 6.9 (6.7–7.1) | 59.0 (58.6–59.4) | 26.2 (25.6–26.8) | 24.2 (23.7–24.8) | 22.4 (21.9–23.2) | |||||
2014 | 7.3 (7.1–7.6) | 58.4 (58.0–58.8) | 25.7 (25.1–26.2) | 23.8 (23.3–24.4) | 22.5 (21.9–23.3) | |||||
2015 | 7.5 (7.3–7.8) | 57.7 (57.3–58.1) | 25.6 (25.0–26.2) | 23.2 (22.7–23.8) | 20.9 (20.4–21.8) | |||||
2016 | 7.8 (7.5–8.0) | 57.2 (56.7–57.5) | 24.8 (24.2–25.4) | 22.7 (22.1–23.3) | 18.9 (18.4–19.8) | |||||
2017 | 8.2 (7.9–8.5) | 56.9 (56.5–57.4) | 24.6 (23.9–25.2) | 22.3 (21.7–23.0) | 19.0 (18.4–19.9) | |||||
2018 | 8.6 (8.3–8.8) | 56.6 (56.2–57.0) | 24.5 (23.9–25.1) | 22.1 (21.5–22.8) | 20.2 (19.7–21.1) | |||||
2019 | 8.9 (8.7–9.2) | 56.3 (55.8–56.7) | 24.6 (23.9–25.1) | 22.2 (21.5–22.8) | 21.9 (21.4–22.7) | |||||
2020 | 9.4 (9.1–9.6) | 56.1 (55.6–56.4) | 23.9 (23.2–24.4) | 21.9 (21.3–22.5) | 22.3 (21.7–23.1) | |||||
Season (quarter) | 0.015 | 0.009 | < 0.001 | < 0.0001 | < 0.001 | |||||
1 | 8.2 (6.5–9.9) | 57.8 (56.7–58.9) | 25.4 (24.2–26.2) | 23.5 (22.2–24.7) | 20.8 (18.6–22.8) | |||||
2 | 8.1 (6.3–9.9) | 57.5 (56.3–58.5) | 25.3 (24.1–26.2) | 23.1 (21.8–24.3) | 20.7 (18.4–22.7) | |||||
3 | 7.9 (6.2–9.8) | 56.9 (55.7–57.9) | 24.3 (23.1–25.2) | 22.3 (21.0–23.6) | 20.9 (18.5–22.9) | |||||
4 | 8.3 (6.6–10.0) | 57.2 (56.1–58.2) | 24.7 (23.5–25.6) | 22.7 (21.5–23.9) | 21.9 (19.7–23.9) | |||||
Census regiona | 0.003 | < 0.001 | < 0.001 | < 0.001 | 0.005 | |||||
East North Central | 5.7 (3.7–7.6) | 55.9 (54.4–57.3) | 21.6 (19.8–22.9) | 18.7 (16.9–20.5) | 20.2 (17.6–23.0) | |||||
East South Central | 9.2 (7.2–11.1) | 64.2 (62.6–65.7) | 29.1 (27.3–30.4) | 28.2 (26.3–30.0) | 23.1 (20.4–25.7) | |||||
Middle Atlantic | 8.1 (6.2–10.1) | 58.6 (57.2–60.1) | 22.9 (21.1–24.1) | 22.4 (20.6–24.2) | 21.2 (18.6–24.1) | |||||
Mountain | 4.9 (3.0–6.9) | 57.3 (55.9–58.8) | 22.5 (20.6–23.7) | 17.6 (15.8–19.4) | 16.6 (14.0–19.2) | |||||
New England | 12.1 (10.9–13.3) | 65.5 (64.5–66.5) | 23.5 (21.9–24.7) | 19.6 (18.4–20.9) | 18.8 (16.6–21.4) | |||||
Pacific | 10.6 (8.6–12.5) | 56.1 (54.6–57.6) | 25.8 (24.0–27.1) | 22.6 (20.8–24.4) | 17.9 (15.2–20.5) | |||||
South Atlantic | 7.4 (5.4–9.3) | 52.5 (51.0–54.0) | 23.7 (21.9–25.0) | 22.7 (20.9–24.5) | 22.9 (20.3–25.6) | |||||
West North Central | 8.8 (7.6–10.0) | 52.4 (51.4–53.3) | 24.3 (22.8–25.5) | 24.6 (23.4–25.8) | 22.0 (19.9–24.6) | |||||
West South Central | 8.6 (6.6–10.5) | 54.1 (52.7–55.6) | 26.3 (24.4–27.7) | 22.7 (20.9–24.5) | 21.4 (18.7–24.1) |
Trends in antibiotic-resistant urinary Enterobacterales by pathogen
Characteristics | ESBL | Beta-lactam | Trimethoprim/sulfamethoxazole | Fluoroquinolones | Nitrofurantoin | |||||
---|---|---|---|---|---|---|---|---|---|---|
Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | |
Year | < 0.001 | < 0.001 | 0.029 | < 0.001 | < 0.001 | |||||
2011 | 6.3 (6.0–6.6) | 54.7 (53.9–55.5) | 27.7 (27.2–28.2) | 26.0 (25.3–26.6) | 4.5 (3.4–5.5) | |||||
2012 | 6.6 (6.3–6.9) | 54.1 (53.3–54.9) | 29.3 (28.8–29.8) | 27.0 (26.4–27.5) | 6.5 (5.4–7.5) | |||||
2013 | 6.8 (6.6–7.1) | 53.4 (52.6–54.1) | 28.9 (28.4–29.4) | 26.5 (25.9–27.0) | 6.2 (5.1–7.1) | |||||
2014 | 7.4 (7.1–7.7) | 52.9 (52.1–53.7) | 28.8 (28.3–29.3) | 26.3 (25.7–26.8) | 6.2 (4.9–7.2) | |||||
2015 | 7.7 (7.4–8.0) | 52.1 (51.4–52.9) | 28.5 (27.9–29.0) | 25.8 (25.2–26.3) | 4.6 (2.9–5.7) | |||||
2016 | 8.1 (7.8–8.4) | 51.5 (50.6–52.3) | 27.6 (27.1–28.1) | 25.5 (24.9–26.0) | 3.5 (1.9–4.6) | |||||
2017 | 8.6 (8.3–8.9) | 51.2 (50.4–52.1) | 27.7 (27.1–28.2) | 25.3 (24.7–25.9) | 3.5 (1.9–4.6) | |||||
2018 | 9.1 (8.8–9.4) | 50.9 (50.1–51.8) | 28.1 (27.6–28.7) | 25.3 (24.7–26.0) | 3.9 (2.3–5.0) | |||||
2019 | 9.7 (9.4–10.0) | 50.8 (49.9–51.5) | 28.6 (28.0–29.2) | 25.6 (24.9–26.2) | 4.3 (2.7–5.4) | |||||
2020 | 9.8 (9.5–10.2) | 50.6 (49.7–51.4) | 27.3 (26.7–27.8) | 25.7 (25.0–26.3) | 4.1 (2.4–5.2) | |||||
Season (quarter) | 0.009 | < 0.001 | 0.001 | < 0.001 | 0.031 | |||||
1 | 8.6 (6.3–10.8) | 52.6 (51.6–53.6) | 28.6 (27.3–29.4) | 26.4 (26.2–26.6) | 4.6 (3.3–6.4) | |||||
2 | 8.4 (6.2–10.8) | 52.0 (51.0–53.0) | 28.5 (27.1–29.3) | 26.2 (26.0–26.5) | 4.6 (3.3–6.4) | |||||
3 | 8.3 (6.0–10.7) | 51.0 (49.9–52.0) | 27.6 (26.2–28.5) | 25.1 (24.9–25.4) | 4.3 (3.0–6.1) | |||||
4 | 8.7 (6.5–11.0) | 51.5 (50.5–52.5) | 27.9 (26.5–28.6) | 25.5 (25.2–25.7) | 4.4 (3.0–6.2) | |||||
Census region | < 0.001 | < 0.001 | < 0.001 | < 0.001 | 0.044 | |||||
East North Central | 5.7 (3.1–8.2) | 47.4 (45.6–49.2) | 24.5 (22.5–25.6) | 20.8 (19.9–21.6) | 3.9 (2.6–5.9) | |||||
East South Central | 9.8 (7.2–12.3) | 59.1 (57.2–60.9) | 33.1 (31.2–34.3) | 32.2 (31.3–33.0) | 5.4 (3.9–7.2) | |||||
Middle Atlantic | 8.4 (5.8–10.9) | 51.1 (49.4–52.9) | 25.4 (23.5–26.5) | 24.1 (23.2–24.9) | 4.5 (3.1–6.4) | |||||
Mountain | 5.1 (2.6–7.6) | 48.4 (46.7–50.2) | 23.7 (21.9–24.9) | 20.3 (19.4–21.1) | 3.8 (2.4–5.6) | |||||
New England | 11.8 (10.3–13.4) | 61.5 (60.1–62.8) | 26.4 (25.1–27.7) | 21.3 (20.5–22.0) | 2.7 (2.1–3.5) | |||||
Pacific | 10.8 (8.3–13.4) | 49.8 (48.0–51.5) | 27.7 (25.8–28.9) | 24.5 (23.6–25.2) | 4.2 (2.8–6.2) | |||||
South Atlantic | 7.6 (5.1–10.2) | 47.4 (45.7–49.2) | 27.7 (25.8–28.8) | 26.6 (25.7–27.4) | 4.6 (3.3–6.5) | |||||
West North Central | 11.6 (10.1–13.2) | 46.1 (44.8–47.4) | 26.2 (24.8–27.5) | 26.6 (25.7–27.3) | 2.8 (2.1–4.8) | |||||
West South Central | 9.2 (6.6–11.7) | 53.2 (51.4–55.0) | 30.6 (28.7–31.8) | 26.5 (25.6–27.3) | 4.4 (3.0–6.4) |
Characteristics | ESBL | Beta-lactam | Trimethoprim–sulfamethoxazole | Fluoroquinolones | Nitrofurantoin | |||||
---|---|---|---|---|---|---|---|---|---|---|
Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | Est (95% CI) | P | |
Year | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 | |||||
2011 | 6.3 (6.2–6.4) | 92.8 (92.3–93.4) | 11.0 (10.9–11.2) | 6.7 (4.6–8.0) | 58.5 (57.1–59.7) | |||||
2012 | 6.4 (6.2–6.5) | 91.4 (90.9–91.9) | 10.4 (10.2–10.6) | 6.9 (4.9–8.2) | 60.0 (58.6–61.2) | |||||
2013 | 6.4 (6.3–6.5) | 89.5 (88.9–90.0) | 9.9 (9.6–10.1) | 6.9 (4.9–8.2) | 60.8 (59.4–62.0) | |||||
2014 | 6.6 (6.4–6.7) | 87.7 (87.1–88.2) | 9.3 (9.0–9.5) | 5.6 (3.4–6.9) | 59.8 (58.4–61.0) | |||||
2015 | 6.6 (6.5–6.7) | 86.8 (86.2–87.3) | 10.5 (10.2–10.7) | 6.2 (5.0–7.5) | 57.2 (55.8–58.4) | |||||
2016 | 6.6 (6.5–6.7) | 85.8 (85.3–86.4) | 10.4 (10.2–10.6) | 5.9 (4.7–7.1) | 52.5 (51.2–53.9) | |||||
2017 | 6.7 (6.6–6.9) | 84.9 (84.3–85.5) | 10.3 (10.0–10.5) | 5.9 (4.7–7.1) | 53.4 (52.0–54.8) | |||||
2018 | 6.8 (6.7–7.0) | 84.0 (83.5–84.6) | 10.6 (10.3–10.8) | 6.0 (4.8–7.2) | 54.7 (53.3–56.1) | |||||
2019 | 6.9 (6.8–7.1) | 82.8 (82.2–83.4) | 11.4 (11.1–11.6) | 6.3 (5.1–7.6) | 55.4 (54.0–56.8) | |||||
2020 | 7.2 (7.0–7.3) | 81.1 (80.5–81.7) | 11.3 (11.1–11.5) | 6.8 (5.6–7.1) | 59.2 (57.9–60.6) | |||||
Season (quarter) | 0.336 | 0.038 | 0.310 | 0.060 | < 0.001 | |||||
1 | 6.9 (6.1–7.8) | 86.1 (81.9–90.3) | 10.8 (9.2–12.1) | 6.5 (5.7–7.4) | 55.8 (51.3–60.1) | |||||
2 | 6.8 (6.0–7.7) | 85.6 (81.1–89.8) | 10.5 (9.0–11.9) | 6.3 (5.4–7.1) | 55.4 (50.6–59.7) | |||||
3 | 6.7 (5.9–7.5) | 85.1 (80.9–89.3) | 10.4 (8.8–11.8) | 6.1 (5.2–6.9) | 57.2 (52.3–61.5) | |||||
4 | 6.6 (5.8–7.4) | 84.8 (80.3–89.0) | 10.7 (9.1–12.2) | 6.2 (5.3–7.1) | 57.7 (53.0–62.0) | |||||
Census region | 0.003 | < 0.001 | 0.050 | < 0.001 | 0.033 | |||||
East North Central | 5.1 (4.1–6.0) | 93.5 (88.8–98.2) | 9.2 (7.3–10.6) | 6.2 (5.2–7.2) | 54.2 (48.5–59.6) | |||||
East South Central | 7.2 (6.2–8.3) | 91.4 (86.3–96.2) | 11.6 (10.0–13.0) | 6.8 (5.7–7.8) | 58.0 (52.3–62.7) | |||||
Middle Atlantic | 7.1 (6.1–8.1) | 93.3 (88.6–98.0) | 10.7 (9.0–12.2) | 5.4 (4.3–6.4) | 56.6 (50.9–61.9) | |||||
Mountain | 4.7 (3.8–5.7) | 86.4 (81.7–91.2) | 8.1 (6.6–9.5) | 3.6 (2.9–4.6) | 52.6 (46.9–57.8) | |||||
New England | 3.6 (3.0–4.2) | 85.2 (82.3–88.1) | 7.9 (7.1–8.8) | 7.0 (5.9–8.1) | 56.1 (52.0–61.3) | |||||
Pacific | 8.6 (7.6–9.6) | 87.6 (82.9–92.3) | 10.7 (8.8–12.1) | 7.0 (5.9–8.0) | 56.4 (50.7–61.8) | |||||
South Atlantic | 7.0 (6.0–7.9) | 74.7 (70.0–79.5) | 10.7 (8.9–12.0) | 7.0 (5.9–8.0) | 61.6 (56.0–67.1) | |||||
West North Central | 3.6 (2.9–4.3) | 94.9 (91.9–97.7) | 7.8 (6.3–9.0) | 2.0 (1.1–3.0) | 48.2 (43.9–53.4) | |||||
West South Central | 7.2 (6.2–8.1) | 69.4 (64.6–74.1) | 11.7 (9.7–13.3) | 6.4 (5.3–7.5) | 55.6 (50.0–61.1) |