Table 1.
Model-Estimated Overall Prevalence of AMR for Each Phenotype, AMR Trend Over Year (2011–2019), and Regional Differences in Nonsusceptibility Among Outpatient Urine E. coli Isolates
| Phenotype Category (N = 1 513 882) | ||||||
|---|---|---|---|---|---|---|
| TMP-SMX NS (n = 384 304) | FQ NS (n = 319 354) | NFT NS (n = 56 954) | ESBL+ (n = 96 306) | NS ≥ 2 Drug Classes (n = 217 329) | NS ≥ 3 Drug Classes (n = 57 637) | |
| Overall (across years) estimate of AMR, % (95% CI) | 26.0 (25.9 to 26.1) | 23.0 (22.9 to 23.2) | 4.0 (4.0 to 4.1) | 6.8 (6.7 to 6.8) | 15.7 (15.5 to 15.8) | 4.2 (4.1 to 4.3) |
| Trend over year (2011–2019): average yearly change in NS, % (95% CI) | 0.0 (–0.2 to 0.1; p = 0.6737) | –0.6 (–0.8 to –0.4; P < .0001) | –6.1 (–6.5 to –5.6; P < .0001) | 7.7 (7.2 to 8.2; P < .0001) | –0.8 (–1.1 to –0.6; P < .0001) | 2.7 (2.2 to 3.2; P < .0001) |
| Variation in AMR by US Census Region (2011–2019), % (95% CI)* | ||||||
| East North Central (n = 354 353) | 22.3 (21.8 to 22.7) | 15.2 (14.8 to 15.7) | 3.4 (3.2 to 3.6) | 4.1 (3.9 to 4.4) | 10.7 (10.3 to 11.1) | 2.8 (2.6 to 3.0) |
| East South Central (n = 173 127) | 29.4 (28.9 to 30.1) | 22.8 (22.2 to 23.5) | 4.5 (4.2 to 4.7) | 6.5 (6.1 to 6.9) | 16.7 (16.1 to 17.3) | 4.4 (4.1 to 4.7) |
| Middle Atlantic (n = 265 840) | 21.9 (21.4 to 22.3) | 15.8 (15.3 to 16.3) | 3.7 (3.5 to 4.0) | 4.7 (4.4 to 5.0) | 11.3 (10.9 to 11.8) | 3.1 (2.8 to 3.3) |
| Mountain (n = 58 407) | 21.6 (21.0 to 22.2) | 14.8 (14.3 to 15.4) | 3.8 (3.5 to 4.1) | 3.9 (3.6 to 4.2) | 10.3 (9.8 to 10.8) | 2.2 (2.0 to 2.4) |
| New England (n = 19 450) | 17.1 (16.3 to 17.9) | 10.6 (10.0 to 11.2) | 2.5 (2.2 to 2.9) | 3.0 (2.7 to 3.4) | 7.0 (6.5 to 7.5) | 1.6 (1.4 to 1.9) |
| Pacific (n = 173 228) | 25.3 (24.7 to 25.9) | 16.5 (16.0 to 17.0) | 3.6 (3.4 to 3.9) | 7.5 (7.0 to 8.0) | 12.9 (12.4 to 13.4) | 3.7 (3.4 to 4.0) |
| South Atlantic (n = 205 042) | 26.2 (25.6 to 26.8) | 19.3 (18.7 to 19.9) | 4.4 (4.2 to 4.7) | 5.1 (4.8 to 5.5) | 13.9 (13.4 to 14.4) | 3.5 (3.2 to 3.8) |
| West North Central (n = 18 448) | 21.3 (20.4 to 22.2) | 11.7 (11.1 to 12.4) | 3.1 (2.7 to 3.5) | 3.5 (3.2 to 3.9) | 8.5 (7.9 to 9.1) | 1.6 (1.4 to 1.8) |
| West South Central (n = 245 987) | 29.1 (28.5 to 29.7) | 20.1 (19.5 to 20.7) | 3.7 (3.5 to 3.9) | 5.8 (5.4 to 6.1) | 14.7 (14.2 to 15.3) | 3.5 (3.3 to 3.8) |
Models were adjusted for hospital characteristics (bed size, urban/rural status, and teaching status).
East North Central: IL, IN, MI, OH, WI; East South Central: AL, KY, MS, TN; Middle Atlantic: NJ, NY, PA; Mountain: AZ, CO, ID, MT, NM, NV, UT, WY; New England: CT, MA, ME, NH, RI, VT; Pacific: AK, CA, OR, WA; South Atlantic: DE, DC, FL, GA, MD, NC, SC, VA, WV; West North Central: IA, KS, MN, MO, ND, NE, SD; West South Central: AR, LA, OK, TX.
Abbreviations: AMR, antimicrobial resistance; CI, confidence interval; E. coli, Escherichia coli; ESBL+, extended-spectrum β-lactamase-producing; FQ, fluoroquinolone; NFT, nitrofurantoin; NS, nonsusceptible; TMP-SMX, trimethoprim-sulfamethoxazole.*Significant variation between regions and age groups was found, P < .0001.