Trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in the community: the Vigil'Roc multicenter studies

Objective - This study was performed in order to describe the trends and ep idemiology of antimicrobial resistance in Enterobacteriaceae isolated in th e community. Materiel and methods - In 1993, 1997 and 2000, 9290 strains of Enterobacter iaceae were isolated in community lab settings and their susceptibility to antibiotics evaluated by the disk method according to the French recommenda tions (CA-SFM). Epidemiological data concerning medical history of patients were simultaneously collected. Results - Samples are essentially provided from urinary tract (88.7 %) and from women (79.5 %). 88.2 % of the strains are Escherichia coli and Proteus mirabilis. Over the three studies, we observe an increasing resistance to penicillins, coamoxiclav and cotrimoxazole for E. coli, to coamoxiclav for P. mirabilis and to penicillins for Salmonella sp. Ceftriaxone, gentamicin and ciprofloxacin retain a very good activity. Producers of extended-spectr um beta -lactamase are detected for a rising number of species, but strains remain rare (0.5%). Analysing, by logistic regression, the risk factors fo r adults to be infected by a resistant strain of E. coli, lead to observe a narrow association of antimicrobial resistance with prior antibiotherapy a nd a relative specificity between the family of prior antibiotics and the c ompound affected by bacterial resistance. Prior hospitalisation is preferen tially linked to multiresistance and age > 60 years is associated with cefi xime and quinolone resistance and with multiresistance. Resistance of E. co li to penicillins is more elevated in children than in adults, and is also linked to a prior antibiotic use by children. Some comparable results are p rovided in univariate analysis for P. mirabilis and Salmonella sp. (C) 2001 Editions scientifiques et medicales Elsevier SAS.