Association between socioeconomic environment, antibiotic consumption, and risk of community-acquired Extended-Spectrum Beta-Lactamase-producing Escherichia coli Urinary Tract Infections: a population-based study.

INTRODUCTION: Evidence on how socio-demographic determinants and population-level antibiotic consumption increase the risk of community-acquired ESBL-producing Escherichia coli urinary tract infections (UTIs) remains limited. METHODS: We used negative binomial regression to assess the association between community-level socio-economic factors, antibiotic consumption, and the risk of urinary tract infection caused by ESBL-producing E. coli. We conducted a cross-sectional, population-based study including individuals living in 353 predefined geographical statistical areas (GSA) across France. Socio-demographic, living condition, and healthcare indicators were extracted from national administrative databases. RESULTS: Among 537,610 urine samples with E. coli growth, 16,536 were ESBL-positive, corresponding to a prevalence of 2.5% (IQR 1.9-3.2) per GSA. Patients had a mean age of 60.1 years (SD 22.4), and 16% were men. In multivariate analysis, community-acquired ESBL-producing E. coli UTIs were associated with the proportion of the population aged under 5 years (adjusted IRR 1.08 [1.04-1.13], p<0.001), poverty rate (aIRR 1.02 [1.00-1.04], p=0.027), overcrowded households (aIRR 1.02 [1.01-1.02],p<0.001), the consumption of fluoroquinolones (aIRR 1.46 [1.19-1.79], p<0.001), macrolides (aIRR 1.11 [1.07-1.17], p<0.001), and tetracyclines (aIRR 1.14 [1.07-1.22], p<0.001). CONCLUSION: These findings suggest that overcrowding, higher poverty rate or increased antibiotic consumption are independently associated with the number of community-acquired ESBL-producing E. coli UTIs at the supra-municipal level.