Journal article
Spatial pattern and risk factors of resistance to important antibiotics among E. coli from veterans in seven U.S. Midwest states
Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e35
01/01/2026
DOI: 10.1017/ash.2025.10292
PMCID: PMC12854879
PMID: 41625132
Abstract
Background: Effective antibiotic stewardship programing in clinical settings necessitates a good understanding of local prevalences of antimicrobial resistance and important patient and community risk factors. However, most studies are limited in sample size and geographic coverage. Methods: This study utilized phenotypic resistance data of Escherichia coli from the Veteran’s Health Administration of the United States (U.S.), incorporating 126,777 unique cultures from veteran outpatients from seven Midwest states from 2010 to 2023, to examine the spatial pattern and important individual- and county-level risk factors for resistance to four important classes of antibiotics. We utilized Bayesian conditional autoregressive zero-inflated Poisson regression models to generate smoothed rates of resistance in each county and multilevel logistic regression models to detect risk factors for resistance. Results: High overall rates of resistance were seen for fluoroquinolone (29%) and TMP-SMX (22%). Geographic variation was seen among and between antibiotic classes. Certain urban regions in the southern parts of Illinois, Indiana, and Ohio had higher local resistance rates for fluoroquinolone and TMP-SMX. Being male, having diabetes, and previous exposure to antibiotics are significant risk factors for all classes of antibiotics while the significance of other risk factors varied across classes. Conclusion: Diverse geographic patterns of resistance level may reflect differences in local prescribing practices, while the differential correlations with risk factors likely reflect their clinical indications and prescribing patterns in clinical settings. The local resistance rates and risk factors for different classes of antibiotics should provide important guidance in practicing empirical prescribing and antibiotic stewardship in clinical settings.
Details
- Title: Subtitle
- Spatial pattern and risk factors of resistance to important antibiotics among E. coli from veterans in seven U.S. Midwest states
- Creators
- Zhuo Tang - Texas Tech UniversityQianyi Shi - University of IowaShinya HasegawaMargaret CarrelJacob Oleson - University of IowaMichihiko Goto - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e35
- DOI
- 10.1017/ash.2025.10292
- PMID
- 41625132
- PMCID
- PMC12854879
- NLM abbreviation
- Antimicrob Steward Healthc Epidemiol
- ISSN
- 2732-494X
- eISSN
- 2732-494X
- Publisher
- Cambridge University Press
- Grant note
- Centers for Disease Control and Prevention Epicenter program award: CK000613 Agency for Healthcare Research and Quality: K08HS027472
The work was supported by the Centers for Disease Control and Prevention Epicenter program award CK000613 (MC) and the Agency for Healthcare Research and Quality under award number K08HS027472 (MG). ZT, QS, SH and JO report no relevant funding sources. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Centers for Disease Control and Prevent, the Department of Veterans Affairs or the United States Government. The funders have no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
- Language
- English
- Date published
- 01/01/2026
- Academic Unit
- Epidemiology; Biostatistics; School of Earth, Environment, and Sustainability; Otolaryngology; Internal Medicine
- Record Identifier
- 9985131449402771
Metrics
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