How strong is the evidence that antibiotic use is a risk factor for antibiotic-resistant, community-acquired urinary tract infection?

• Published in: Journal of antimicrobial chemotherapy 2002-08, Vol.50 (2), p.241-247
• Main Authors: Hillier, Sharon L., Magee, John T., Howard, Anthony J., Palmer, Stephen R.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents; Anti-Infective Agents, Urinary - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Drug Resistance, Bacterial - physiology; Evidence-Based Medicine - statistics & numerical data; General aspects; Humans; Medical sciences; Pharmacology. Drug treatments; Risk Factors; Urinary Tract Infections - drug therapy; Urinary Tract Infections - epidemiology
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkf121

The prevalence of antibiotic resistance in community-acquired infections is rising but in contrast to popular perception there has been little published work on its epidemiology. This systematic review evaluates the published evidence on the relationship between antibiotic prescribing and antibiotic resistance of organisms causing community-acquired urinary tract infection. Fourteen papers met the inclusion criteria and these reported on five ecological studies and ten studies of individuals. Only one ecological study provided good evidence of a link with prescribing rates. The remaining studies had no control for population differences in demographics and/or no comparison population. Studies at the individual level lacked clear case definitions and statistical power. Until the epidemiology of antibiotic resistance is better defined the design of effective interventions will not be possible.