ABSTRACT
We analyzed the association between antibiotic resistance and recurrent urinary tract infection (rUTI) by Escherichia coli. Susceptibility levels to 14 antimicrobial agents and the presence of extended-spectrum ß-lactamases (ESBL) were established using MicroScan. Incidences of multidrug resistant (MDR), extensively drug resistant (XDR), and ESBL-producer isolates as well as rUTIs were estimated. The time to recurrence was established adjusted for number of antibiotic-resistant families and MDR as predictors of interest, respectively. Overall, 8,553 urinary tract infection (UTI) cases related to E. coli, including 963 rITU, were analyzed with levels of resistance >30% in all cases, except for amikacin, nitrofurantoin, and carbapenems. The incidence of rUTI was of 11.3%, being 46.5%, 24.3%, and 42.5% for MDR, XDR, and ESBLs, respectively. Bivariate analysis showed that rUTI was associated with age, gender, resistance to specific antimicrobials, MDR, and XDR. The number of antibiotic families tested as resistant, MDR, XDR, gender, and age were associated with time to recurrence when adjusted for number of antibiotic families, and MDR, gender, and age were related when adjusted for MDR. High rates of antibiotic resistance to the usual antibiotics was observed in E. coli causing UTI, with female sex, age, and antibiotic resistance being risk factors for the development of rUTI.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Multiple, Bacterial , Escherichia coli Infections/microbiology , Urinary Tract Infections/microbiology , Adult , Age Factors , Aged , Aged, 80 and over , Escherichia coli , Escherichia coli Infections/epidemiology , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Recurrence , Retrospective Studies , Sex Factors , Urinary Tract Infections/epidemiology , beta-Lactamases/drug effectsABSTRACT
PURPOSE: Although international policies promote programs for correction of refractive errors in school children, recent studies report low compliance with respect to spectacle wear. Our aim was to assess spectacle-wear compliance and identify associated visual factors among children participating in Chile's school spectacle provision program. METHODS: A total of 270 school children were prescribed spectacles and monitored after 1 year. Visual acuity, refractive error, reasons for not wearing spectacles, and self-reported visual function were assessed. Compliance is reported as the proportion of children wearing spectacles at the 1-year visit. Factors associated with compliance and reasons for not wearing spectacles were examined using contingency table analyses. Logistic models were constructed to assess independently associated factors. RESULTS: Only 204 children (76%) participated in the 1-year follow-up. Mean age was 10 years (range 4-19 years); 58% were girls, 42% boys. Overall compliance was 58%. Spectacle use was independently associated with age and refractive error. Older children were less likely to be compliant (odds ratio, OR, 0.8, 95% confidence interval, CI, 0.76-0.92/year of increasing age). Compared with children with refractions of -0.75 to +0.75 diopters, both myopic and hyperopic children were more compliant (OR 4.93, 95% CI 2.28-10.67 and OR 2.37, 95% CI 1.06-5.31, respectively). Primary reasons for not wearing spectacles included breakage/loss in younger children, and disliking the appearance in teenagers. CONCLUSION: We found greater compliance in spectacle wear than that reported in most published studies. Guidelines for provision of children's spectacles should consider excluding children with mild refractive error and improving spectacle quality and appearance.
