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Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection:  a case-control study

Hillier, Sharon, Roberts, Zoe Elizabeth Sara, Dunstan, Frank David John ORCID:, Butler, Christopher Collett ORCID:, Howard, Anthony and Palmer, Stephen Royston 2007. Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection:  a case-control study. Journal of Antimicrobial Chemotherapy 60 (1) , pp. 92-99. 10.1093/jac/dkm141

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Background To assess the effect of previous antibiotic use on the risk of a resistant Escherichia coli urinary tract infection (UTI), we undertook a case–control study with prospective measurement of outcomes in 10 general practices in the UK. Methods Urinary samples from all patients with symptoms suggestive of UTIs were sought, and those with a laboratory-proven E. coli infection were interviewed and their medical records examined. Case patients were those with ampicillin- or trimethoprim-resistant infections and control patients had infections that were susceptible to antibiotics, including ampicillin and trimethoprim. Results Risk of ampicillin-resistant E. coli infection in 903 patients was associated with amoxicillin prescriptions of ?7 days duration in the previous 1 month [odds ratio (OR) = 3.91, 95% CI 1.64–9.34] and previous 2–3 months (2.29, 1.12–4.70) before illness onset. For prescriptions <7 days duration, there was no statistically significant association. Higher doses of amoxicillin were associated with lower risk of ampicillin resistance. For trimethoprim-resistant E. coli infections, the OR was 8.44 (3.12–22.86) for prescriptions of trimethoprim of ?7 days in the previous month and 13.91 (3.32–58.31) for the previous 2–3 months. For trimethoprim prescriptions of <7 days, the OR was 4.03 (1.69–9.59) for the previous month but prescribing in earlier periods was not significantly associated with resistance. Conclusions Within the community setting, exposure to antibiotics is a strong risk factor for a resistant E. coli UTI. High-dose, shorter-duration antibiotic regimens may reduce the pressure on the emergence of antibiotic resistance.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Uncontrolled Keywords: antibiotics, resistance, UTIs, epidemiology
Publisher: Oxford University Press
ISSN: 1460-2091
Last Modified: 02 May 2023 18:32

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