JAC Advance Access originally published online on May 31, 2005
Journal of Antimicrobial Chemotherapy 2005 56(1):146-153; doi:10.1093/jac/dki181
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The relationship between primary care antibiotic prescribing and bacterial resistance in adults in the community: a controlled observational study using individual patient data
1 Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol, BS6 6JL, UK; 2 Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY, UK; 3 Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK; 4 Bristol Centre for Antimicrobial Research and Evaluation, Department of Medical Microbiology, Southmead Hospital, Bristol, BS10 5NB, UK; 5 Health Protection Agency, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK; 6 Health Protection Agency South West, The Wheelhouse, Bonds Mill, Stonehouse, Gloucestershire, GL10 3RS, UK; 7 City of Bristol College, Bedminster, Bristol, BS3 5JL, UK; 8 Richard Bright Renal Unit, Southmead Hospital, Bristol, BS10 5NB, UK
Received 21 December 2004; returned 20 February 2005; revised 28 April 2005; accepted 29 April 2005
* Corresponding author. Tel: +44-117-954-6632; Fax: +44-117-954-6677; E-mail: alastair.hay{at}bristol.ac.uk
Objectives: To examine the relationship between primary care prescribed antibiotics and the development of antibiotic resistance in perineal flora contaminating unselected urinary isolates from a large sample of asymptomatic adults representative of the general community.
Patients and methods: Escherichia coli isolates contaminating urine samples were obtained from asymptomatic adults aged >16 years registered with general practices in the former Avon and Gloucestershire health authority areas. Data on antibiotic exposure during the 12 months prior to providing the urine samples were collected from the primary care electronic and paper medical records. The main outcome measure was resistance to amoxicillin or trimethoprim or both.
Results: Two thousand nine hundred and forty-three adults submitted urine samples. Susceptibility among E. coli isolates and antibiotic prescribing data were available from 618 patients. We found no evidence of an association between resistance and patients' exposure to any antibiotic prescribed in primary care in the previous 12 months [adjusted odds ratio (OR) 1.12, 95% confidence interval 0.77–1.65, P = 0.52]. Secondary analyses demonstrated greater resistance in patients exposed to antibiotics within 2 months (adjusted OR 1.95, 1.08–3.49, P = 0.03), a dose–response relationship to increasing exposure to trimethoprim in the previous 12 months (adjusted OR 1.01, 1.01–1.02, P = 0.001) and that individuals who had been prescribed any ß-lactam antibiotic in the previous 12 months had amoxicillin MICs more than twice (adjusted 95% CI 1.23–3.31, P = 0.009) that of those who had not been prescribed any ß-lactams.
Conclusions: Whether or not adults receive a prescription for any antibiotic during a 12 month period does not appear to influence the antimicrobial resistance of perineal flora. However, the temporal and dose–response relationships found may be suggestive of a causative association and should be the focus of further research.
Keywords: primary health care , antibiotics , drug resistance , patient level data
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