Computerized Decision Support System (CDSS) Use for Surveillance of Antimicrobial Resistance in Urinary Tract Infections in Primary Care - Sorbonne Université Access content directly
Journal Articles Journal of Antimicrobial Chemotherapy Year : 2022

Computerized Decision Support System (CDSS) Use for Surveillance of Antimicrobial Resistance in Urinary Tract Infections in Primary Care

Abstract

Abstract Background Hospital-based surveillance of antimicrobial resistance may be irrelevant as a guide to antimicrobial use for urinary tract infections (UTIs) in primary care. Objectives To highlight the value of online computerized decision support systems (CDSS) in providing information on the surveillance of antimicrobial resistance in community-acquired UTIs. Methods We collected the susceptibility profile for key antibiotics by type of UTI involving Escherichia coli from 2017 to 2020, using queries for UTI (Q-UTI) submitted to a French CDSS. We compared these results with those from the MedQual French surveillance system for community-acquired UTI and the European Antimicrobial Resistance Surveillance Network (EARS-NET) for invasive infections. Results We collected 43\mkern1mu591 Q-UTI, of which 10\mkern1mu192 (23%) involved E. coli: 40% cystitis, 32% male-UTI, and 27% pyelonephritis. Resistance was 41.3% (95% CI, 40.3%\textendash 42.2%) for amoxicillin, 16.6% (95% CI, 15.9%\textendash 17.3%) for fluoroquinolones, 6.6% (95% CI, 6.1%\textendash 7.0%) for third-generation cephalosporins (3GC), and 5.7% (95% CI, 5.2%\textendash 6.1%) for aminoglycosides. Resistance to amoxicillin was lower than that reported in MedQual (42.7%, P value\mkern1mu=\mkern1mu0.004), and in EARS-NET (55.2%, P value\mkern1mu<\mkern1mu0.001). For fluoroquinolones, resistance was higher than in MedQual (12.0%, P value\mkern1mu<\mkern1mu0.001) and EARS-NET (15.8%, P value\mkern1mu=\mkern1mu0.041). In complicated pyelonephritis and male UTI, fluoroquinolone resistance peaked at ∼20%. For 3GC, all UTI had higher resistance than in MedQual (3.5%, P value\mkern1mu<\mkern1mu0.001), but lower than in EARS-NET (9.5%, P value\mkern1mu<\mkern1mu0.001). Aminoglycoside resistance was not reported by MedQual, and was lower than in EARS-NET (7.1%, P value\mkern1mu<\mkern1mu0.001). Conclusions CDSS can inform prescribers in real-time about the ecology and surveillance of E. coli resistance in community-acquired UTI. In complicated upper UTIs, they can underline the risk of empirical use of fluoroquinolones and suggest preferential use of 3GC.
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Dates and versions

hal-03888700 , version 1 (13-02-2023)

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Tristan Delory, Josselin Le Bel, Sylvie Lariven, Nathan Peiffer-Smadja, François-Xavier Lescure, et al.. Computerized Decision Support System (CDSS) Use for Surveillance of Antimicrobial Resistance in Urinary Tract Infections in Primary Care. Journal of Antimicrobial Chemotherapy, 2022, 77 (2), pp.524--530. ⟨10.1093/jac/dkab392⟩. ⟨hal-03888700⟩
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