Antimicrobial susceptibility patterns of community-acquired uropathogenic Escherichia coli, Dublin 2010–2022
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Background. Escherichia coli is a common cause of urinary tract infections. Due to the increase in antimicrobial resistance (AMR) and global differences in antimicrobial susceptibility data, routine assessment of local antimicrobial susceptibility patterns is necessary to guide the selection of appropriate empirical therapy. The aim of this study was to evaluate the antimicrobial susceptibility patterns of community-acquired uropathogenic Escherichia coli within a catchment area in Dublin over a 13 year period, 2010–2022.
Methods. All mid-stream urine samples received from local general practitioners in which there was significant E. coli bacteriuria during the study period, 2010–2022, were included in the analysis. Antimicrobial susceptibility testing was performed by disc diffusion as per the European Committee on Antimicrobial Susceptibility Testing recommendations.
Results. An average of 11 407 urine samples per month had significant bacteriuria, with E. coli accounting for an average of 67 % of those. Overall AMR rates were highest for ampicillin (53.9 %), followed by trimethoprim (32.4 %), gentamicin (18.6 %), co-amoxiclav (16.5 %), ciprofloxacin (12.3 %), cephalexin (8.3 %), cefpodoxime (6.8 %) and nitrofurantoin (2 %). While rates appeared grossly static, statistically significant reduced resistance rates were noted for co-amoxiclav (r s =−0.95; P =<0.001), cephalexin prior to 2019 (r s =−0.783; P =0.013) and trimethoprim (r s =−0.639; P =0.019), with a statistically significant increase in non-susceptibility to cefpodoxime (r s =0.802; P =0.001).
Conclusions. In order to generate efficient empirical antimicrobial prescribing guidelines, knowledge of region-specific contemporaneous antimicrobial susceptibility patterns is pivotal. Our findings support the use of nitrofurantoin or cephalexin as empirical antimicrobial therapy within our setting.
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The paper is well presented, thorough and provides a useful addition to existing literature on AMR surveillance. The authors have responded to all reviewer comments appropriately.
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The reviewers and I agree that your manuscript is well presented and that the research is scientifically sound. The reviewers make some small suggestions for clarity that I would like you to incorporate into a resubmission.
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Comments to Author
Knowledge about the local prevalence of antibiotic resistance is important and needed in order to adequately and quickly treat patients suffering from infections with (potentially) antibiotic resistant pathogens. This paper, titled "Antimicrobial Susceptibility Patterns of Community-Acquired Uropathogenic Escherichia coli, Dublin 2010-2022" does exactly that - the authors are giving detailed information on AMR trends over time in a local collection of E. coli samples. The data is presented well and neatly summarised in tabular and graphic form. The results are clear and (potential) flaws of the study are clearly mentioned. Authors do not over-interpret their data, by for example linking it to other data like antibiotic usage, as this sample collection is clearly biased but nonetheless important for …
Comments to Author
Knowledge about the local prevalence of antibiotic resistance is important and needed in order to adequately and quickly treat patients suffering from infections with (potentially) antibiotic resistant pathogens. This paper, titled "Antimicrobial Susceptibility Patterns of Community-Acquired Uropathogenic Escherichia coli, Dublin 2010-2022" does exactly that - the authors are giving detailed information on AMR trends over time in a local collection of E. coli samples. The data is presented well and neatly summarised in tabular and graphic form. The results are clear and (potential) flaws of the study are clearly mentioned. Authors do not over-interpret their data, by for example linking it to other data like antibiotic usage, as this sample collection is clearly biased but nonetheless important for the community. I have only to comments / requests: In Figure 2, the datapoints of "Coamoxiclav uncomplicated" for the years 2010, 2011, 2012, and 2013 should be completely removed as according to table 1 this drug was not tested in those years. The datapoints indicate a percentage of non-susceptible isolates of 0%. Due to the completely different criteria of selecting samples for testing towards Cephalexin resistance, this antibiotic should be split into two groups (pre- and post-change of the policy). Only then, trends can be properly analysed. It is not clear from the text if this has been done or not.
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
Ali and Ryan have produced a great short paper documenting the rates of resistance of uropathoenic E. coli from urine infections. This manuscript is well written, with clear data, methods and conclusions and I really enjoyed reading it. I have a few minor suggestions to improve the manuscript but advise it is accepted for publication after the edits have been made. In the introduction the authors do a great job of introducing E. coli and UTIs. I think this section could be improved by adding in one or two sentences explaining what AMR is and why it is important (with some recent references). For Fig.1 I think it would be better (in the table underneath the x axis) to state the first row is "Year" as this is currently undefined, then "E. coli isolates", "non-E. coli isolates" and perhaps add a "Total" …
Comments to Author
Ali and Ryan have produced a great short paper documenting the rates of resistance of uropathoenic E. coli from urine infections. This manuscript is well written, with clear data, methods and conclusions and I really enjoyed reading it. I have a few minor suggestions to improve the manuscript but advise it is accepted for publication after the edits have been made. In the introduction the authors do a great job of introducing E. coli and UTIs. I think this section could be improved by adding in one or two sentences explaining what AMR is and why it is important (with some recent references). For Fig.1 I think it would be better (in the table underneath the x axis) to state the first row is "Year" as this is currently undefined, then "E. coli isolates", "non-E. coli isolates" and perhaps add a "Total" row beneath it, which is the number of all the isolates showing significant bacteriuria. Similarly for Fig. 2, add a label on the X axis for "year" As mentioned above, I really enjoyed reading this manuscript, it was well written with clear data and a nice story. I'd like to thank the authors for collating such a large amount of susceptibility data on CA-UPEC and think this will be of benefit to clinicians and researchers working on AMR.
Please rate the manuscript for methodological rigour
Very good
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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