The study analysed bloodstream isolates from the Calgary Health Zone, Canada, between 2006 and 2022, comprising 7,271 Staphylococcus aureus, 1,609 Enterococcus faecalis, 801 Enterococcus faecium, 11,363 Escherichia coli and 2,319 Klebsiella pneumoniae. Whole genome sequences were assigned to strains, then linked to susceptibility phenotypes and antimicrobial prescribing rates. Community fluoroquinolone prescribing fell 6.8% a year and hospital prescribing 5.1% a year from 2010. S aureus bacteraemia resistant to cloxacillin, ciprofloxacin, erythromycin and clindamycin fell 16.0% a year, mostly in hospital-onset cases. Community-onset E coli ST1193 rose 17.7% a year, and CTX-M-27-producing ST131 rose 23.8% a year, alongside rising community cephalosporin prescribing of 7.3% a year. The analysis covers one metropolitan area, and prescribing associations are ecological rather than individual.
Why it is interesting: Resistance trends diverge by organism within one health system, so prescribing restraint does not act uniformly. Strain-level genomics shows which lineages drive community-onset resistance.
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