Patient population flow diagram based on signs of tissue invasion, empirical therapy and culture result.

<p>The denominator of the given percentage per box was derived from the number given in the box one level up.^aConsisted of fever (>38°C) and flank pain.^bBased on the presence of ≥10³ cfu/mL uropathogens on the urine dipslide.</p

Antibiotic susceptibility of Gram-negative uropathogens.

<p><b>NOTE.</b> AMOX  =  amoxicillin; AMC  =  co-amoxiclav; TMP  =  trimethoprim; SXT  =  co-trimoxazole; NOR  =  norfloxacin; CIP  =  ciprofloxacin; NIT  =  nitrofurantoin.^aConsist of Pseudomonas and Acinetobacter species.^bConsist of Morganella, Citrobacter, Serratia, Pasteurella, Providentia and Enterobacter species.</p

Distribution of isolated uropathogens per age category.

<p><b>NOTE.</b> Values are given in percentages.</p>a<p>Consist of Pseudomonas and Acinetobacter species.</p>b<p>Consist of Morganella, Citrobacter, Serratia, Pasteurella, Providentia and Enterobacter species.</p>c<p>Consist of <i>Staphylococcus saprophyticus, Staphylococcus aureus</i> and Streptococcus species</p><p>No trends with age were observed for the given uropathogens (all P>0.05).</p

General characteristics of general practitioners (GPs) and patients, n (%).

<p>^a cattle: horses, cows, chickens or pigs</p><p>^b exclusion criterium</p><p>NA: not applicable</p><p>General characteristics of general practitioners (GPs) and patients, n (%).</p

Patient, general practitioner (GP) and practice factors associated with <i>Staphylococcus aureus (</i>SA) positive swabs in patients (multivariate model).

<p>^a yes = 1 versus no = 0</p><p>^b p < 0.0001</p><p>^c p = 0.002</p><p>^d p = 0.0006</p><p>^e p = 0.001</p><p>Patient, general practitioner (GP) and practice factors associated with <i>Staphylococcus aureus (</i>SA) positive swabs in patients (multivariate model).</p

Total number and percentage of SA and MRSA carrier-ship in patients and GPs.

<p>Total number and percentage of SA and MRSA carrier-ship in patients and GPs.</p

<i>Escherichia coli</i> antibiotic susceptibility between 2004 and 2011 studies according to guidelines used for susceptibility breakpoints.

<p><b>NOTE.</b> Values are given in percentages.</p><p>No significant differences in <i>E. coli</i> susceptiblilities (EUCAST) were observed between 2004 and 2011 study (all P>0.05)</p

Significant determinants of urinary and faecal <i>Escherichia coli</i> antimicrobial resistance.

<p><b>NOTE.</b> OR = odds ratio, 95% CI = 95% confidence interval, SXT = trimethoprim/sulfamethoxazole.</p>a<p>Women who had not taken any antimicrobial agent in the previous three months were used as reference group for the calculation of ORs of the association between antimicrobial resistance and (specific) antimicrobial use.</p>b<p>Adjusted for age, UTI history, antibiotic use in the previous three months and presence or absence of complicating host factors.</p

Baseline characteristics of women from whom an <i>Escherichia coli</i> strain was isolated, stratified for the origin of the sample.

<p><b>NOTE.</b> SD = standard deviation, SXT = trimethoprim/sulfamethoxazole. Numbers are n (%), unless otherwise stated.</p

Antibiotic Exposure and Other Risk Factors for Antimicrobial Resistance in Nasal Commensal <i>Staphylococcus aureus</i>: An Ecological Study in 8 European Countries

<div><p>Objectives</p><p>Antimicrobial resistance (AMR) has become a global public health concern which threatens the effective treatment of bacterial infections. Resistant <i>Staphylococcus aureus</i> (including MRSA) increasingly appears in individuals with no healthcare associated risks. Our study assessed risk factors for nasal carriage of resistant <i>S</i>. <i>aureus</i> in a multinational, healthy, community-based population, including ecological exposure to antibiotics.</p><p>Methods</p><p>Data were collected in eight European countries (Austria, Belgium, Croatia, France, Hungary, the Netherlands, Spain and Sweden). Commensal AMR patterns were assessed by collecting 28,929 nasal swabs from healthy persons (aged 4+). Ecological exposure to antibiotics was operationalized as systemic antibiotic treatment patterns, extracted from electronic medical records of primary care practices in which the participants were listed (10–27 per country). A multilevel analysis related AMR in nasal commensal <i>S</i>. <i>aureus</i> to antibiotic exposure and other risk factors (e.g. age and profession).</p><p>Results</p><p>Of the 6,093 <i>S</i>. <i>aureus</i> isolates, 77% showed resistance to at least one antibiotic. 7.1% exhibited multidrug resistance (defined as resistance to 3 or more antibiotic classes), and we found 78 cases MRSA (1.3%). A large variation in antibiotic exposure was found between and within countries. Younger age and a higher proportion of penicillin prescriptions in a practice were associated with higher odds for carriage of a resistant <i>S</i>. <i>aureus</i>. Also, we found higher multidrug resistance rates in participants working in healthcare or nurseries.</p><p>Conclusions</p><p>This study indicates that in a population with no recent antibiotic use, the prescription behavior of the general practitioner affects the odds for carriage of a resistant <i>S</i>. <i>aureus</i>, highlighting the need for cautious prescribing in primary care. Finally, since variation in AMR could partly be explained on a national level, policy initiatives to decrease AMR should be encouraged at the national level within Europe.</p></div