JAC Advance Access published online on May 30, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm141
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Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection: a case–control study
1 Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4YS, UK 2 Department of General Practice, Centre for Health Sciences Research, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4YS, UK 3 National Public Health Service for Wales, Temple of Peace and Health, Cathays Park, Cardiff CF10 3NW, UK
Received 2 January 2007; returned 5 February 2007; revised 4 April 2007; accepted 10 April 2007
* Corresponding author. E-mail: palmersr{at}cardiff.ac.uk
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.
Key Words: antibiotics , resistance , UTIs , epidemiology
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