{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:43:59Z","timestamp":1788925439379,"version":"build-2803163510"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Extended-spectrum \u03b2-lactamase (ESBL)\u2013producing\n Escherichia coli<\/jats:italic>\n is considered a leading pathogen contributing to the global burden of antimicrobial resistance.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To better understand factors associated with the heterogeneity of community-acquired ESBL-producing\n E coli<\/jats:italic>\n urinary tract infections (UTIs) in France.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of\n E coli<\/jats:italic>\n isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing\n E coli<\/jats:italic>\n strains isolated from urine samples of individuals with community-acquired UTI in 2019.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 444\u202f281\n E coli<\/jats:italic>\n isolates from urine samples tested in 1013 laboratories, the mean prevalence of ESBL-producing\n E coli<\/jats:italic>\n was 3.0% (range, 1.4%-8.8%). In an adjusted model, the number of community-acquired ESBL-producing\n E coli<\/jats:italic>\n UTIs in each department was positively associated with the percentage of children younger than 5 years (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, 0.112 [95% CI, 0.040-0.185];\n P<\/jats:italic>\n \u2009=\u2009.004), overcrowded households (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, 0.049 [95% CI, 0.034 to 0.062];\n P<\/jats:italic>\n \u2009&lt;\u2009.001), consumption of fluoroquinolones (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, 0.002 [95% CI, 0.001-0.002];\n P<\/jats:italic>\n \u2009&lt;\u2009.001), and tetracyclines (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, 0.0002 [0.00004 to 0.00039];\n P<\/jats:italic>\n \u2009=\u2009.02), and poultry density (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, 0.0001 [95% CI, 0.0001-0.0002];\n P<\/jats:italic>\n \u2009&lt;\u2009.001). The social deprivation index (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, \u22120.115 [95% CI, \u22120.165 to \u22120.064];\n P<\/jats:italic>\n \u2009&lt;\u2009.001) and the proportion of water surface area (adjusted \u03b2\n 1<\/jats:sub>\n coefficient, \u22120.052 [\u22120.081 to \u22120.024];\n P<\/jats:italic>\n \u2009=\u2009.001) were negatively associated with a higher number of community-acquired ESBL-producing\n E coli<\/jats:italic>\n UTIs.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n The findings of this cross-sectional study suggest that multiple human health, animal health, and environmental factors are associated with the occurence of community-acquired ESBL\n E coli<\/jats:italic>\n UTI. Strategies to mitigate ESBL in the community should follow the One Health approach and address the role played by fluoroquinolones, tetracycline use, poultry density, overcrowded households, and preschool-aged children.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.32679","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T11:04:59Z","timestamp":1663758299000},"page":"e2232679","source":"Crossref","is-referenced-by-count":22,"title":["Assessment of Factors Associated With Community-Acquired Extended-Spectrum \u03b2-Lactamase\u2013Producing\n Escherichia coli<\/i>\n Urinary Tract Infections in France"],"prefix":"10.1001","volume":"5","author":[{"given":"Adeline","family":"Paumier","sequence":"first","affiliation":[{"name":"Centre d\u2019Appui \u00e0 la Pr\u00e9vention des Infections Associ\u00e9es aux Soins des Pays de la Loire, Centre Hospitalier Universitaire (CHU)\u2013Le Tourville, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Asquier-Khati","sequence":"additional","affiliation":[{"name":"Centre d\u2019Appui \u00e0 la Pr\u00e9vention des Infections Associ\u00e9es aux Soins des Pays de la Loire, Centre Hospitalier Universitaire (CHU)\u2013Le Tourville, Nantes, France"},{"name":"Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Thibaut","sequence":"additional","affiliation":[{"name":"French National Surveillance System of Antimicrobial Resistance in Primary Care and Nursing Homes, PRIMO, CHU\u2013Le Tourville, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Coeffic","sequence":"additional","affiliation":[{"name":"French National Surveillance System of Antimicrobial Resistance in Primary Care and Nursing Homes, PRIMO, CHU\u2013Le Tourville, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Lemenand","sequence":"additional","affiliation":[{"name":"French National Surveillance System of Antimicrobial Resistance in Primary Care and Nursing Homes, PRIMO, CHU\u2013Le Tourville, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Larramendy","sequence":"additional","affiliation":[{"name":"Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brice","family":"Lecl\u00e8re","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Nantes and Centre d\u2019Investigation Clinique 1413, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Nantes, 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