Trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in community settings: 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 co mmunity, settings. Material and methods - In 1993, 1997 and 2000, 9,290 strains of Enterobacte riaceae were isolated in community lab settings and their susceptibility to antibiotics evaluated by the disk method according to French recommendatio ns (CA-SFM). Epidemiological data concerning the medical history of patient s was simultaneously collected. Results - Samples were mostly from the urinary tract (88.7%) and women (79. 5%). 88.2% of the strains were Escherichia coli and Proteus mirabilis. Over the three studies, we noted an increasing resistance to penicillins, coamo xiclav, and cotrimoxazole for E. coli, to coamoxiclav for P. mirabilis, and to penicillins for Salmonella sp. Ceftriaxone, gentamicin, and ciprofloxac in remained very active. Producers of extended-spectrum beta -lactamase wer e detected for a rising number of species, but strains remained rare (0.5%) . The analysis, by logistic regression, of the risk factors for adults to b e infected by a resistant strain of E. coli, lead to observe a narrow assoc iation of antimicrobial resistance with prior antibiotherapy, and a relativ e specificity between the family of prior antibiotics and the compound affe cted by bacterial resistance. Prior hospitalization was preferentially link ed to multiresistance and age > 60 years was associated with cefixime and q uinolone resistance and with multiresistance. Resistance of E coil to penic illins was more elevated in children than in adults, and was also linked to a prior antibiotic use by children. Some comparable results were obtained through a univariate analysis for P mirabilis and Salmonella sp. (C) 2001 E ditions scientifiques et medicales Elsevier SAS.