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J Antimicrob Chemother. 2007 Jul;60(1):92-9. Epub 2007 May 30.

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

Author information

1
Department of Epidemiology, Centre for Health Sciences Research, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4YS, UK.

Abstract

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 >or=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 >or=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.

PMID:
17540675
DOI:
10.1093/jac/dkm141
[Indexed for MEDLINE]

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