Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015-2020: a cross-sectional analysis.

IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Courtney W Chan, Leo K Westgard, Andrew Romasco, Krisztian Gado, Shira Doron, Maya L Nadimpalli
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引用次数: 0

Abstract

Background: Antibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients' risks for acquiring antibiotic-resistant (AR) uropathogens.

Methods: We identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients' age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients' sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients' census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients' risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.

Results: We included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients' odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients' odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.

Conclusion: The social determinants of health may play important and intersecting roles in determining a patient's risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.

2015-2020 年波士顿一家医院门诊尿液培养中抗生素耐药性的社会人口差异:横断面分析。
背景:随着时间的推移,泌尿病原体的抗生素耐药性迅速升级,使治疗变得复杂,并增加了发病率和死亡率。很少有研究探讨健康的社会决定因素如何与患者感染耐抗生素(AR)泌尿病原体的风险相关:我们确定了 2015 年至 2020 年期间从塔夫茨医疗中心初级保健诊所门诊患者处收集的尿培养物。如果电子病历 (EMR) 中记录了患者的年龄、性别和居住地址,且尿培养结果显示为肠球菌属或一种或多种革兰氏阴性细菌,或进行了抗生素敏感性分析和菌种鉴定,则样本将被纳入其中。我们从电子病历中提取了患者的社会人口学特征,并使用美国人口普查局的数据确定了患者居住地的人口统计特征。我们使用逻辑回归模型和Bonferroni校正法评估了个人和社区层面的特征与患者尿培养对以下药物耐药的风险之间的关系:(1) 三类或更多抗生素(即耐多药[MDR]);(2) 一线治疗;(3) 氟喹诺酮类;(4) 氨基糖苷类;或 (5) 头孢曲松:我们纳入了 1306 名门诊患者的尿培养结果,其中大部分为女性(89%)。患者大多自我认同为非西班牙裔白人(36%)、亚裔(15%)或非西班牙裔黑人(11%)。超过 60% 的患者居住在环境正义指定的人口普查区。大部分分离菌株为大肠埃希菌(76%)或肺炎克雷伯菌(7%)。使用公共保险会增加患者感染对一线抗生素耐药的尿路病原体的几率,但生活在低收入社区的患者感染 MDR 尿路病原体的几率会降低 47%。我们注意到,讲英语以外的语言与氨糖苷类药物耐药尿路病原体之间存在强烈但不显著的正相关趋势(p 值 = 0.02)。最值得注意的是,在控制了其他因素后,我们没有观察到种族或民族与耐氨糖苷尿路病原体之间有统计学意义的关联:结论:健康的社会决定因素在决定患者感染耐药尿路病原体的风险方面可能起着重要的交叉作用,而耐药尿路病原体的治疗更具挑战性或更加昂贵。关键是要认识到种族可能是影响健康的其他因素的替代物,并考虑到某些群体可能会受到抗生素耐药性不成比例的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.80
自引率
4.20%
发文量
162
审稿时长
28 weeks
期刊介绍: International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.
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