Antimicrobial resistance in urinary «Escherichia coli» in Quebec, Canada
Notice bibliographique
Résumé
Background: Urinary tract infections caused by the bacteria Escherichia coli are among the most common infections in the world.Resistance to the antimicrobials used to treat these infections is a growing concern.Given the lack of new drug development, it is critically important to understand the factors underlying patterns of antimicrobial resistance. Methods:The individual-level predictors of resistance to six antimicrobials (ampicillin, gentamicin, ciprofloxacin, nitrofurantoin, trimethoprim/sulfamethoxazole, tobramycin) were investigated in community-acquired and nosocomial urinary E. coli isolates from three cities in the province of Quebec, Canada between April 2010 and December 2017.Hierarchical logistic regression models were used to account for correlations among the six types of resistance.We employed time series analysis in the form of dynamic linear models to explore the temporal association between oral fluoroquinolone use and ciprofloxacin resistance in isolates from the city of Montreal.Fluoroquinolone use in Montreal was estimated using a 25% sample of individuals insured under the public drug prescription plan up to December 2014.Results: Both community-acquired and nosocomial isolates showed geographic variability in the prevalence of resistance.Male sex and recent hospitalization were predictors of increased resistance for most types of resistance; additionally, ciprofloxacin resistance increased sharply with age.Distinct seasonal patterns were noted for community-acquired and nosocomial infections, and resistance in the community setting has been rising since 2015.In Montreal, we found a positive correlation between total fluoroquinolone use lagged by 1 and 2 months and the monthly proportion of isolates resistant to ciprofloxacin. Conclusions:These results demonstrate that hierarchical modelling of the prevalence of, and risk factors for, many types of antimicrobial resistance allows general and region-specific inference, which may inform empirical therapy.The observed correlation between fluoroquinolone use and ciprofloxacin resistance supports the rationale for antimicrobial stewardship campaigns to reduce fluoroquinolone prescriptions in the community setting.i Preface In this thesis, I investigate the extent to which individual-level and population-level factors explain variability in the prevalence of antimicrobial resistance in urinary E. coli isolates in the province of Quebec, Canada.First, I give a rationale for this research and outline the two main objectives of the thesis (Chapter 1).Chapter 2 introduces the topics of urinary tract infections and antimicrobial resistance.A summary of the epidemiological and clinical literature on risk factors for antimicrobial resistance in urinary E. coli isolates is given, as well as an overview of antimicrobial consumption in Canada and its connection to variation in the prevalence of antimicrobial resistance.Chapter 3 describes the study methodology, including study location, population, and rationale for the statistical analyses.The results are presented in the form of two manuscripts in Chapter 4. Finally, the results are discussed in Chapter 5, with concluding remarks in Chapter 6. References are provided in Chapter 7.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».