Drug-resistant Escherichia coli, rural Idaho.Stool carriage of drug-resistant Escherichia coli Escherichia coli (ĕsh'ərĭk`ēə kō`lī), common bacterium that normally inhabits the intestinal tracts of humans and animals, but can cause infection in other parts of the body, especially the urinary tract. in home-living residents of a rural community was examined. Carriage of nalidixic acid-resistant E. coli E. coli: see Escherichia coli. E. coli in full Escherichia coli Species of bacterium that inhabits the stomach and intestines. E. coli can be transmitted by water, milk, food, or flies and other insects. was associated with recent use of antimicrobial agents Antimicrobial agents Chemical compounds biosynthetically or synthetically produced which either destroy or usefully suppress the growth or metabolism of a variety of microscopic or submicroscopic forms of life. in the household. Household clustering of drug-resistant E. coli was observed. Most carriers of drug-resistant E. coli lacked conventional risk factors. ********** Acquisition of drug-resistant Escherichia coli may be influenced by food, exposure to flora of contacts, and use of antimicrobial agents (1-3). Few community studies have explored the contribution of these mechanisms to dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there of drug-resistant E. coli in healthy persons (4-6). We examined epidemiologic ep·i·de·mi·ol·o·gy n. The branch of medicine that deals with the study of the causes, distribution, and control of disease in populations. [Medieval Latin epid factors associated with colonization colonization, extension of political and economic control over an area by a state whose nationals have occupied the area and usually possess organizational or technological superiority over the native population. by drug-resistant E. coli in home-living volunteers who were not recruited through healthcare settings (7,8). Resistance to trimethoprim/sulfamethoxazole (TMP/SMZ), nalidixic acid nalidixic acid /nal·i·dix·ic ac·id/ (nal-i-dik´sik) a synthetic antibacterial agent used in the treatment of genitourinary infections caused by gram-negative organisms. na·li·dix·ic acid n. (NA), and extended-spectrum cephalosporins Cephalosporins Definition Cephalosporins are medicines that kill bacteria or prevent their growth. Purpose Cephalosporins are used to treat infections in different parts of the body—the ears, nose, throat, lungs, sinuses, and (ESCs) was examined (9,10). The Study From March to May 2002, a convenience sample of household volunteers was recruited from 1 rural community in Idaho. Consenting adults consenting adults npl → adultos con capacidad de consentir consenting adults npl → personnes consentantes consenting adults npl and parents of children completed an exposure questionnaire. The questionnaire assessed dietary history dietary history, n See analysis, dietary. and livestock contact during the previous month, and other exposures, including antimicrobial antimicrobial /an·ti·mi·cro·bi·al/ (-mi-kro´be-al) 1. killing microorganisms or suppressing their multiplication or growth. 2. an agent with such effects. drug use and travel outside the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. during the past 6 months. The study was reviewed and approved by the Western Institutional Review Board (Olympia, WA, USA). Information on antimicrobial drug prescriptions filled by community pharmacies in the preceding year was obtained (beginning March 2001). Pharmacy-documented antimicrobial drug prescriptions were compared with self-reported use. The definition of antimicrobial drug use was either pharmacy documentation of an antimicrobial drug prescription or self-reported use of a named antimicrobial agent obtained from a plausible nonpharmacy (e.g., free sample from a doctor's office) or out-of-area source, with dates of use. Recent antimicrobial drug use was defined as use [less than or equal to] 30 days before collection of stool swabs. Study participants were instructed to use a CultureSwab (Becton Dickinson BD (NYSE: BDX), is a medical technology company that manufactures and sells medical devices, instrument systems and reagents. Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD employs 27,000 people in nearly 50 countries. , Franklin Lakes, NJ, USA) to collect fecal fecal /fe·cal/ (fe´k'l) pertaining to or of the nature of feces. fe·cal adj. Relating to or composed of feces. fecal pertaining to or of the nature of feces. material. All samples were refrigerated re·frig·er·ate tr.v. re·frig·er·at·ed, re·frig·er·at·ing, re·frig·er·ates 1. To cool or chill (a substance). 2. To preserve (food) by chilling. and transported to the Idaho State Bureau of Laboratories (state laboratory) in Boise, Idaho “Boise” redirects here. For other uses, see Boise (disambiguation). Boise is the capital and most populous city of the U.S. state of Idaho. It is the county seat of Ada County and the principal city of the Boise metropolitan area. . At the state laboratory, samples were streaked across 3 MacConkey agar MacConkey (also McConkey) agar is a culture medium designed to grow Gram-negative bacteria and stain them for lactose fermentation. It contains bile salts, crystal violet dye (to inhibit Gram-positive bacteria), neutral red dye (which stains microbes fermenting lactose), plates, each containing 1 screening antimicrobial agent (16 mg/L TMP/SMZ, 16 mg/L NA, or 2 mg/L cefotaxime). One phenotypically distinct colony type per plate was further analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. . Putative Alleged; supposed; reputed. A putative father is the individual who is alleged to be the father of an illegitimate child. A putative marriage is one that has been contracted in Good Faith and pursuant to ignorance, by one or both parties, that certain E. coli colonies were confirmed by using the Microscan system (Dade Behring Inc., Deerfield, IL, USA). Susceptibility susceptibility the state of being susceptible. Refers usually to infectious disease but may be to physical factors such as wetting or to psychological factors such as harassment. was assessed by MIC using broth broth liquid media for culturing microorganisms. cooked meat broth a medium useful for culturing anaerobic bacteria. enrichment broth one modified to permit growth by selected bacteria. microdilution (Microscan) for cefpodoxime, ceftazidime, ceftriaxone ceftriaxone /cef·tri·ax·one/ (cef?tri-ak´son) a semisynthetic, ß–resistant, third-generation cephalosporin effective against a wide range of gram-positive and gram-negative bacteria, used as the sodium salt. , and TMP/SMZ and the Etest (AB-BIODISK, Solna, Sweden) for NA. Manufacturer-specified procedures and reference strains were used, along with Clinical and Laboratory Standards (CSLI CSLI Center for the Study of Language and Information CSLI Civil Society and Local Initiatives ) (formerly National Committee for Clinical Laboratory Standards [NCCLS NCCLS National Committee for Clinical Laboratory Standards ]) guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. . The CSLI/NCCLS criteria were used to classify isolates as resistant to TMP/SMZ, NA, or ESC See escape character and escape key. See also ESC/P. ESC - escape . Resistance to ESC was defined as resistance to ceftriaxone (MIC [greater than or equal to] 64 [micro]g/mL), ceftazidime (MIC [greater than or equal to] 32 [micro]g/mL), or cefpodoxime (MIC [greater than or equal to] 8 [micro]g/mL) (11). A sample was resistant if at least 1 E. coli isolate from that sample exhibited the corresponding resistance phenotype phenotype (fē`nətīp'): see genetics. phenotype All the observable characteristics of an organism, such as shape, size, colour, and behaviour, that result from the interaction of its genotype (total genetic makeup) with . The primary endpoints were intestinal carriage of E. coli resistant to the 3 targeted antimicrobial drug classes. Carriage of NA-resistant and TMP/SMZ-resistant E. coli were examined separately by comparing carriers and non-carriers of NA-resistant and TMP/SMZ-resistant E. coli. Regression models were constructed in which study participants were divided into 3 mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" groups: carriers of NA-resistant E. coli (either TMP/SMZ resistant or susceptible), carriers of TMP/SMZ-resistant/NA-susceptible E. coli, and persons who did not carry either resistance (reference group). Crude and adjusted odds ratios were estimated by using generalized estimating equations to account for household-level clustering. Statistical significance was defined as a p value [greater than or equal to] 0.05. Analyses were performed with Stata version 8.0 (Stata Corporation, College Station, TX, USA). Stool swabs were received from 517 study participants representing 167 households (Table 1). The prevalence of intestinal carriage of E. coli resistant to NA was 3%, to TMP/SMZ 11%, and to ESCs 1%. All 6 ESC-resistant isolates were found so based on their resistance to cefpodoxime. The ceftazidime MIC was in the susceptible range for 5 of these isolates ([less than or equal to] 4 [micro]g/mL for 2 and 8 [micro]g/mL for 3) and intermediate for 1 isolate (16 [micro]g/mL). The isolate with intermediate susceptibility to ceftazidime also showed intermediate resistance to ceftriaxone (32 [micro]g/mL). Use of antimicrobial agents was associated with carriage of NA-resistant but not TMP/SMZ-resistant E. coli; 6 (16%) of 37 study participants who used antimicrobial agents within 30 days of culture carried NA-resistant E. coli, compared with 10 (2%) of 480 participants who did not use antimicrobial agents. However, significance was lost after accounting for household clustering (p = 0.13). Carriage of TMP/SMX-resistant E. coli was similar in persons with and without recent use of antimicrobial agents; 5 (14%) of 37 study participants with recent use carried TMP/SMZ-resistant E. coli compared with 50 (10%) of 480 persons without recent use (p = 0.84). A similar pattern was seen for recent use of antimicrobial agents in the household. Overall, 92 (18%) persons resided in a household in which at least 1 member recently used antimicrobial agents. Of these, 11 (12%) of 92 carried NA-resistant E. coli, compared with 5 (1%) of 425 in households without recent use. In contrast, the prevalence of carriage of TMP/SMX-resistant E. coli was similar in persons with and without recent household use of antimicrobial agents. When we accounted for household clustering, recent use of antimicrobial agents in the household was associated with 9.2-fold increased odds for carriage of NA-resistant E. coli (p<0.001). Additionally, the presence of another household member with NA-resistant E. coli was associated with 8.8-fold increased odds for NA-resistant E. coli carriage (p<0.001), and the presence of another household member with TMP/SMZ-resistant E. coli was associated with 2.7-fold increased odds for TMP/SMZ-resistant E. coli carriage (p<0.001). Carriage of NA-resistant or TMP/SMZ-resistant E. coli was not associated with age, sex, livestock exposure, dietary history, contact with the healthcare system, or travel outside the United States (Table 2). Approximately 94% of persons in the study ate chicken or ground beef in the previous month (Table 1); 14 of 17 persons who did not eat beef or chicken in the previous month were children [less than or equal to] 5 years of age. The 6 study participants who carried ESC-resistant E. coli belonged to 6 separate households. None had used antimicrobial agents within 30 days of culture and only 1 had household use of antimicrobial agents within 30 days. No other epidemiologic or demographic factors distinguished this group. The small number of persons with carriage of ESC-resistant E. coli precluded further statistical analysis of this endpoint. Of the 517 participants, 34% self reported use of an antimicrobial agent during the previous 6 months (Table 3). Of these, 67% had pharmacy documentation of at least 1 antimicrobial agent prescription. However, 22% of the 339 persons who reported not using antimicrobial agents had pharmacy documentation of at least 1 prescription. Of the 178 persons who reported use of [greater than or equal to] 1 antimicrobial agent, 108 (61%) provided the name of the agent. However, the specific drug named matched the drug listed in the pharmacy records Pharmacy Records is an independent record label based in Melbourne, Australia, and run by Richard Andrew of Registered Nurse. Pharmacy Records is distributed through MGM Distribution in Australia and through Narwhal Records in the UK. for only 29% of the persons. Thirteen persons reported receiving an antimicrobial agent from a nonpharmacy source. Six of the 13 purchased antimicrobial agents in Mexico, 4 received a drug sample from their healthcare provider, and 1 person each received the antimicrobial agent from a dairy, another family member, or a leftover prescription. Conclusions Carriage of E. coli resistant to TMP/SMZ was more common than carriage of E. coli resistant to NA or ESC. There was striking evidence of household clustering of resistance, consistent with either spread of organisms between persons in close contact or common source acquisition, such as through shared contaminated contaminated, v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. food (8,12). Most carriers of drug-resistant E. coli did not have exposures previously associated with antimicrobial drug resistance such as travel, contact with the healthcare system, or chronic illness (13-15). NA resistance was associated with recent use of antimicrobial agents in the household. Use of antimicrobial agents may have enhanced acquisition of exogenous Exogenous Describes facts outside the control of the firm. Converse of endogenous. NA-resistant E. coli; alternatively, for persons who had recently taken fluoroquinolones, NA resistance may have emerged during therapy. Overall, 36% of households had at least 1 member who had received antimicrobial drug treatment within the previous 6 months, illustrating the magnitude of antimicrobial drug selection pressure operating in a community. Self reporting of antimicrobial drug use may be a useful marker of exposure to these drugs when pharmacy records are not available. However, the accuracy with respect to specific drugs was poor. This study did not convincingly support or refute re·fute tr.v. re·fut·ed, re·fut·ing, re·futes 1. To prove to be false or erroneous; overthrow by argument or proof: refute testimony. 2. the hypothesis that contact with contaminated meat contributes to gastrointestinal carriage of drug-resistant E. coli. Only a small number of persons reported not eating meat, and those persons lived in households where other members ate meat. Therefore, persons not exposed to meat were not adequately sampled. The limitations of the study should be acknowledged. Random recruitment of volunteers from the community was not feasible. Since only a single stool specimen was obtained, the duration of carriage of drug-resistant E. coli or the timing of its onset in relation to specific exposures could not be determined. The use of thymidine-containing media (MacConkey agar) may have diminished the activity of TMP/SMZ, thereby reducing the sensitivity of the screening for TMP/SMZ resistance. In conclusion, most home-living residents who carried drug-resistant E. coli lacked conventional risk factors. Household-level antimicrobial drug use was associated with carriage of NA-resistant but not TMP/SMZ-resistant E. coli. The role of the food supply in promoting dissemination of drug-resistant E. coli in human populations warrants more detailed study. This study was supported by Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. grant number RS1 CCR 1. CCR - condition code register. 2. CCR - (Database) concurrency control and recovery. 820631 (MHS (1) (Message Handling Service) An earlier messaging system from Novell that supported multiple operating systems and other messaging protocols, including SMTP, SNADS and X.400. It used the SMF-71 messaging format. ), the National Research Initiative Competitive Grants Program, and US Department of Agriculture grant 00-35212-9408 (JRJ JRJ James R. Johnson & Associates, Inc. ). References (1.) Bonten M, Stobberingh E, Philips J, Houben A. Antibiotic resistance antibiotic resistance, n the ability of certain strains of microorganisms to develop resistance to antibiotics. antibiotic resistance of Escherichia coli in fecal samples of healthy people in two different areas in an industrialized in·dus·tri·al·ize v. in·dus·tri·al·ized, in·dus·tri·al·iz·ing, in·dus·tri·al·iz·es v.tr. 1. To develop industry in (a country or society, for example). 2. country. Infection. 1992;20:258-62. (2.) Manges AR, Johnson JR, Foxman B, O'Bryan TT, Fullerton KE, Riley LW. Widespread distribution of urinary tract infections urinary tract infection (UTI), n infection in one or more of the structures that make up the urinary system. Occurs more often in women and is most commonly caused by bacteria. caused by a multidrug-resistant Escherichia coli clonal clonal referring to a clone. clonal expansion occurs, for example, when B cells, under the influence of T cell interleukins, differentiate into two separate populations and, after several transformations produce sensitized B group. N Engl J Med. 2001;345:1007-13. (3.) Van den Bogaard AE, London N, Driessen C, Stobberingh EE. Antibiotic resistance of faecal fae·cal adj. Chiefly British Variant of fecal. Adj. 1. faecal - of or relating to feces; "fecal matter" fecal Escherichia coli in poultry, poultry farmers poultry farmer n → avicultor/a m/f poultry farmer n → aviculteur m poultry farmer poultry n → and poultry slaughterers. J Antimicrob Chemother. 2001;47:763-71. (4.) Allen UD, MacDonald N, Fuite L, Chan F, Stephens D. Risk factors for resistance to "first-line" antimicrobials among urinary urinary /uri·nary/ (u´ri-nar?e) pertaining to, containing, or secreting urine. u·ri·nar·y adj. 1. Relating to urine and its production, function, or excretion. 2. tract isolates of Escherichia coli in children. CMAJ CMAJ Canadian Medical Association Journal . 1999; 160:1436-40. (5.) Bruinsma N, Hutchinson JM, van den Bogaard AE, Giamarellou H, Degener J, Stobberingh EE. Influence of population density on antibiotic resistance. J Antimicrob Chemother. 2003;51:385-90. (6.) Garau J, Xercavins M, Rodriguez-Carballeira M, Gomez-Vera JR, Coll I, Vidal D, et al. Emergence and dissemination of quinolone-resistant Escherichia coli in the community. Antimicrob Agents Chemother. 1999;43:2736-41. (7.) Enne VI, Livermore DM, Stephens P, Hall LM. Persistence of sulphonamide sulphonamide or US sulfonamide Noun Pharmacol any of a class of organic compounds that prevent the growth of bacteria resistance in Escherichia coli in the UK despite national prescribing restriction. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife. lan·cet n. . 2001;357:1325-8. (8.) Molbak K. Spread of resistant bacteria and resistance genes from animals to humans--the public health consequences. J Vet Med B Infect infect /in·fect/ (in-fekt´) 1. to invade and produce infection in. 2. to transmit a pathogen or disease to. in·fect v. 1. Dis Vet Public Health. 2004;51:364-9. (9.) Bywater RJ. Veterinary use of antimicrobials and emergence of resistance in zoonotic Zoonotic A disease which can be spread from animals to humans. Mentioned in: Zoonosis and sentinal bacteria in the EU. J Vet Med B Infect Dis Vet Public Health. 2004;51:361-3. (10.) Teuber, M. Veterinary use and antibiotic resistance. Curr Opin Microbiol. 2001;4:493-9. (11.) Wikler MA, Cockerill FR, Craig WA. Performance standards for antimicrobial susceptibility resting. Fourteenth informational supplement. Document M100-S14. Wayne (PA): National Committee for Clinical Laboratory Standards; 2004. (12.) Angulo FJ, Nargund VN, Chiller chill·er n. 1. One that chills. 2. A frightening story, especially one involving violence, evil, or the supernatural; a thriller. chiller Noun 1. TC. Evidence of an association between use of anti-microbial agents in food animals and anti-microbial resistance among bacteria isolated from humans and the human health consequences of such resistance. J Vet Med B Infect Dis Vet Public Health. 2004;51:374-9. (13.) Bazile-Pham-Khac S, Truong QC, Lafont JP, Gutmann L, Zhou XY, Osman M, et al. Resistance to fluoroquinolones in Escherichia coli isolated from poultry. Antimicrob Agents Chemother. 1996;40:1504-7. (14.) Bensink JC, Frost AJ, Mathers W, Mutimer MD, Rankin G, Woolcock JB. The isolation of antibiotic antibiotic, any of a variety of substances, usually obtained from microorganisms, that inhibit the growth of or destroy certain other microorganisms. Types of Antibiotics resistant coliforms from meat and sewage. Aust Vet J. 1981;57:12-3, 15-6, 19. (15.) Chulasiri M, Suthienkul O. Antimicrobial resistance of Escherichia coli isolated from chickens. Vet Microbiol. 1989;21:189-94. Elizabeth L. Hannah, * Frederick J. Angulo, ([dagger]) James R. Johnson, ([double dagger double dagger n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) ([section]) Bassam Haddadin, * Jacquelyn Williamson, * and Matthew H. Samore * ([paragraph]) * University of Utah The University of Utah (also The U or the U of U or the UU), located in Salt Lake City, is the flagship public research university in the state of Utah, and one of 10 institutions that make up the Utah System of Higher Education. School of Medicine, Salt Lake City, Utah For ships of the United States Navy of the same name, see . Salt Lake City is the capital and the most populous city of the U.S. state of Utah. The name of the city is often shortened to Salt Lake, or its initials, S.L.C. , USA; ([dagger]) Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ([double dagger]) Veterans Administration Medical Center, Minneapolis, Minnesota “Minneapolis” redirects here. For other uses, see Minneapolis (disambiguation). Minneapolis (pronounced IPA: /ˌmɪniˈæpəlɪs/) is the largest city in the U.S. , USA; ([section]) University of Minnesota (body, education) University of Minnesota - The home of Gopher. http://umn.edu/. Address: Minneapolis, Minnesota, USA. , Minneapolis, Minnesota, USA; and ([paragraph]) Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA Dr Hannah is a research professor in the Department of Community and Environmental Health, College of Health Sciences, Boise State University, Boise, Idaho. Her research interests include antimicrobial resistance, evidence-based medicine evidence-based medicine Decision-making 'The use of scientific data to confirm that proposed diagnostic or therapeutic procedures are appropriate in light of their high probability of producing the best and most favorable outcome'. See Meta-analysis. , using data to improve medical quality, and the intersection between animal and human health. Address for correspondence: Elizabeth L. Hannah, 30 North 1900 East, Room AC230A, Salt Lake City, UT 84132-2901, USA; fax: 208-585 6562; email: lee.hannah@safelink.net
Table 1. Characteristics of 517 study participants collected
from questionnaires and pharmacy data
Characteristic No. (%)
Demographic variables
Male 259 (50)
Income <$35,000/y 339 (66)
Race/ethnicity (n = 497)
White, non-Hispanic 442 (89)
Hispanic/Latino 30 (6)
American Indian/Alaska Native 9 (2)
Asian 6 (1)
African American 5 (1)
North Hawaiian/Pacific Islander 5 (1)
Age, y
[less than or equal to] 6 163 (32)
7-21 103 (20)
22-50 192 (37)
>50 59 (11)
Travel/daycare factors
Child in daycare/preschool 88 (17)
Travel out of United States in past year 22 (4)
Dietary factors
Did not eat hamburger in past month 28 (6)
Ate <1 time/wk 48 (9)
Ate 1-2 times/wk 252 (50)
Ate > 2 times/wk 181 (36)
Did not eat chicken in past month 22 (4)
Ate <1 time/wk 59 (28)
Ate 1-2 times/wk 286 (56)
Ate >2 times/wk 147 (29)
Animal exposure
Live on farm with livestock 5 (1)
Livestock in past month 21 (4)
Cattle 21 (4)
Horses 20 (4)
Sheep 4 (1)
Swine 3 (1)
Poultry 3 (1)
Goats 1 (0)
Household size
<3 (referent) 76 (46)
3-4 53 (32)
>4 38 (23)
Table 2. Comparison of 517 study participants with and without
carriage of antimicrobial drug-resistant Escherichia coli, by
questionnaire responses and pharmacy data *
Noncarriers
(n = 452),
Characteristics no. (%)
Demographic variables
Male 228 (50)
Income <$35,000/y 69 (13)
High school education or less 149 (33)
Hispanic ethnicity 24 (5)
Age, y
[less than or equal to] 6 144 (32)
7-17 71 (16)
18-50 189 (42)
>50 48 (11)
Travel/daycare factors
Child in daycare/preschool 79 (18)
Traveled out of United States 17 (4)
Dietary factors
Ate hamburger, times/week
1-2 219 (49)
>2 164 (37)
Ate chicken, times/week
1-2 254 (56)
>2 127 (28)
Household cook 177 (39)
Primary grocery shopper 169 (37)
Healthcare/antimicrobial drug use
Ambulatory visit in past 6 mo 236 (52)
Diabetic 9 (2)
Hospitalized in past 6 mo 27 (6)
Antimicrobial drug use in past 30 d 209 (46)
Animal exposure in past month
Livestock 32 (7)
Cattle 19 (4)
Horses 18 (4)
Household size ([dagger])
<3 43 (34)
3-4 48 (38)
>4 35 (28)
Household antimicrobial drug use in 21 (17)
past 30 d
TMP/SMZ resistant
(n = 49)
Characteristics No. (%) OR (95% CI)
Demographic variables
Male 24 (49) 1.0 (0.6-1.8)
Income <$35,000/y 10 (20) 1.9 (0.8-4.7)
High school education or less 18 (37) 1.3 (0.6-2.9)
Hispanic ethnicity 6 (12) 2.6 (0.7-9.3)
Age, y
[less than or equal to] 6 16 (33) Ref
7-17 5 (10) 1.3 (0.6-2.8)
18-50 22 (45) 0.8 (0.4-1.5)
>50 6 (12) 0.9 (0.3-2.6)
Travel/daycare factors
Child in daycare/preschool 9 (18) 1.0 (0.5-2.2)
Traveled out of United States 1 (2) 0.4 (0.1-1.7)
Dietary factors
Ate hamburger, times/week
1-2 23 (47) 0.6 (0.3-1.2)
>2 14 (29) 0.6 (0.2-1.3)
Ate chicken, times/week
1-2 23 (47) 0.6 (0.3-1.2)
>2 14 (29) 0.6 (0.3-1.5)
Household cook 21 (44) 1.0 (0.6-1.7)
Primary grocery shopper 20 (41) 1.0 (0.6-1.6)
Healthcare/antimicrobial drug use
Ambulatory visit in past 6 mo 22 (45) 0.8 (0.4-1.3)
Diabetic 3 (6) 2.9 (0.7-11.7)
Hospitalized in past 6 mo 3 (6) 1.0 (0.3-2.5)
Antimicrobial drug use in past 30 d 22 (45) 0.7 (0.2-2.7)
Animal exposure in past month
Livestock 2 (4) 0.5 (0.1-2.1)
Cattle 2 (4) 0.8 (0.2-3.4)
Horses 1 (2) 0.5 (0.1-4.4)
Household size ([dagger])
<3 10 (29) Ref
3-4 11 (31) 0.7 (0.3-1.6)
>4 14 (40) 0.4 (0.2-1.1)
Household antimicrobial drug use in 5 (14) 0.6 (0.2-1.9)
past 30 d
NA resistant
(n = 16)
Characteristics No. (%) OR (95% CI)
Demographic variables
Male 9 (56) 1.1 (0.5-2.4)
Income <$35,000/y 1 (6) 0.8 (0.1-6.7)
High school education or less 3 (19) 0.4 (0.1-2.2)
Hispanic ethnicity 0 (0) --
Age, y
[less than or equal to] 6 3 (19) Ref
7-17 2 (13) 1.5 (0.7-3.0)
18-50 6 (38) 1.3 (0.4-3.7)
>50 5 (31) 1.9 (0.3-13.6)
Travel/daycare factors
Child in daycare/preschool 0 (0) --
Traveled out of United States 4 (25) 6.0 (0.9-39.9)
Dietary factors
Ate hamburger, times/week
1-2 10 (63) 0.7 (0.2-2.0)
>2 4 (25) 0.5 (0.2-1.3)
Ate chicken, times/week
1-2 8 (50) 0.8 0.2-2.6
>2 7 (44) 1.3 (0.4-4.1)
Household cook 7 (44) 0.8 (0.4-1.4)
Primary grocery shopper 8 (50) 1.1 (0.6-1.9)
Healthcare/antimicrobial drug use
Ambulatory visit in past 6 mo 9 (56) 1.1 (0.5-2.3)
Diabetic 1 (6) 1.5 (0.0-117.4)
Hospitalized in past 6 mo 4 (25) 3.4 (0.5-22.4)
Antimicrobial drug use in past 30 d 13 (81) 2.6 (0.7-9.7)
Animal exposure in past month
Livestock 1 (6) 1.6 (0.5-4.9)
Cattle 0 (0) --
Horses 1 (6) 2.3 (0.7-9.6)
Household size ([dagger])
<3 3 (33) Ref
3-4 3 (33) 1.1 (0.2-5.5)
>4 3 (33) 0.4 (0.1-3.4)
Household antimicrobial drug use in 4 (44) 8.4 (2.4-29.2)
past 30 d
* TMP/SMZ, trimethoprim/sulfamethoxazole; NA, nalidixic acid; OR,
odds ratio; CI, confidence interval; Ref, referent.
([dagger]) n = 126 for noncarriers; n = 35 for TMP/SMZ resistant;
n = 9 for NA resistant.
Table 3. Healthcare/antimicrobial use in 517 study participants
collected from questionnaires and pharmacy data *
Characteristic No. (%)
Ambulatory visit in past 6 mo 266 (52)
Diabetic 13 (3)
Antimicrobial use in past month 37 (7)
No. outpatient visits (past 6 mo)
0 251 (49)
1 125 (49)
2 59 (23)
3 29 (11)
4 14 (5)
[greater than or equal to] 5 32 (12)
No. hospitalizations (past 6 mo)
0 483 (93)
1 31 (6)
2 2 (0)
3 1 (0)
No. courses of antimicrobial agents in the past
year
0 333 (64)
1 91 (18)
2 39 (8)
3 19 (4)
4 16 (3)
[greater than or equal to] 5 19 (4)
Antimicrobial classes, no. with
[greater than or equal to] 1 course
TMP/SMZ
Past month 2 (0.4)
Past year 10 (2)
Fluoroquinolones
Past month 7 (1)
Past year 17 (3)
Cephalosporins
Past month 4 (1)
Past year 37 (7)
Penicillin
Past month 18 (4)
Past year 107 (21)
Macrolide
Past month 3 (1)
Past year 24 (5)
* TMP/SMZ, trimethoprim/sulfamethoxazole.
|
|
||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion