Geo-Temporal Variation in the Antimicrobial Resistance of Escherichia coli in the Community

Background: Antimicrobial resistance (AMR) is a global health challenge with significant global variation. Little is known about the prevalence on a smaller geographical scale. Objectives: This study aimed to explore the geo-temporal variation in antibiotic resistance in Escherichia coli (E. coli) urinary isolates in the Illawarra Shoalhaven region, a region south of Sydney. Methods: Data from urine E. coli isolates from people living in the community were geospatially analysed from 2008 to 2018. The proportion of resistant isolates was mapped by antibiotic type (amoxicillin with clavulanic acid, cefalexin, norfloxacin, and trimethoprim), postcode, and year. Results: Resistance varied by antibiotic, postcode, and over time, with some postcodes showing increased resistance one year and a decrease the following year. Areas with consistently higher resistance included metropolitan, port, and lake regions. We found low resistance in E. coli to amoxicillin with clavulanate, cefalexin, and norfloxacin (<5% to 10-19%) and the highest resistance for trimethoprim (10-19% to 30-39%). Overall, from 2008 to 2018, E. coli resistance to all four antibiotics increased in this region. Conclusions: This study shows temporal and geospatial changes in E. coli AMR over small geospatial areas, indicating the opportunity for geospatial analysis to assist in area-specific empirical treatment guidance.