Abstract

BACKGROUND: To investigate differences in distribution of urine isolates and antibiotic resistance patterns in Escherichia coli (E. coli), the predominant uropathogen, in migrants and non-migrant individuals. METHODS: We linked a cohort consisting of all migrants obtaining residence as refugees or family-reunited migrants in Denmark between January 1993 and December 2015 to hospital urine samples examined from January 2000 to December 2015 at the Department of Microbiology, University Hospital Hvidovre, Denmark. Samples from non-migrant individuals, Danish-born from Danish parents, were included as comparison. Analysis was carried out using multivariate logistic regression. RESULTS: 14,561 first time urine samples were included, with E. coli being the most prevalent bacterial pathogen. Of the identified isolates 4,686/11,737 were E. coli among non-migrants and 1,032/2,824 among migrants.Sulfamethoxazol-Trimethoprim resistance was found in 34.3% (350/1020) of E. coli isolates among migrants and 23.2% (1070/4619) among non-migrant patients (Odds ratio (OR) 1.73, 95%CI: 1.47-2.03). Ciprofloxacin resistance was found in 5.8% (36/618) of isolates among migrants and 2.2% (67/3092) among non-migrants (OR 2.20, 95%CI:1.37-3.53). Gentamicin resistance was seen in 10.8% (61/565) and 4.7% (110/2328) of isolates (OR 2.33, 95%CI:1.63-3.34), Cefuroxime resistance in 8.5% (87/1019) and 3.4% (158/4618) (OR 2.40, 95%CI:1.77-3.24), Ampicillin resistance in 51.4% and 40.8% (OR 1.65, 95%CI: 1.42-1.92), and Piperacillin-Tazobactam resistance in 6.9 % (30/432) and 4.2% (65/1532) for migrant and non-migrant patients respectively. When stratifying according to migrant status, family-reunited had higher odds of resistance than refugees for Sulfamethoxazol-Trimethoprim, Gentamicin, and Ampicillin. CONCLUSIONS: Prevalence of antibiotic resistance was significantly higher in E. coli isolates among migrants, both refugees and family reunited, than non-migrant patients. Differences could not be explained by comorbidity or income. The results emphasise the importance of urine sample testing in both local-born and migrants before antibiotic start-up and points to the benefit of considering migration to secure individual treatment and equal health outcomes.