title: Antibiotic Prescribing in Primary Care and Antimicrobial Resistance in Patients Admitted to Hospital with Urinary Tract Infection: A Controlled Observational Pilot Study.
abstract: There is growing evidence that primary care prescribed antibiotics lead to antibiotic resistance in bacteria causing minor infections or being carried by asymptomatic adults, but little research to date has investigated links between primary care prescribed antibiotics and resistance among more serious infections requiring hospital care. Knowledge of these effects is likely to have a major influence on public expectations for, and primary care use of, antibiotics. This study aimed to assess the feasibility of recruiting symptomatic adult patients admitted to hospital with urinary infections and to link primary and secondary data information to investigate the relationship between primary care prescribed antibiotics and antimicrobial resistance in these patients. A microbiology database search of in patients who had submitted a urine sample identified 740 patients who were potentially eligible to take part in the study. Of these, 262 patients did not meet the eligibility criteria, mainly due to use of a urinary catheter (40%). Two-hundred and forty three patients could not be recruited as the nurse was unable to visit the patients prior to discharge, as they were too unwell. Eighty patients provided complete information. Results indicate that there is evidence that prior antibiotic use is associated with resistant infections in hospital patients. A fully powered study, conducted using routinely collected data is proposed to fully clarify the precision of the association.
authors.affiliation: Centre for Primary Care and Public health, Blizzard Institute, Queen Mary University of London, London E1 2AB, UK. C.costelloe@qmul.ac.uk.
authors.forename: Ceire
authors.initials: C
authors.lastname: Costelloe
authors.affiliation: Health Protection Agency Microbiology Services, United Hospital Bristol Trust, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK. martinx.williams@uhbristol.nhs.uk.
authors.forename: O Martin
authors.initials: OM
authors.lastname: Williams
authors.affiliation: Faculty of Medicine and Clinical Sciences, University of Nottingham, Nottingham NG7 2UH, UK. alan.montgomery@nottingham.ac.uk.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Montgomery
authors.affiliation: Institute of Molecular & Experimental Medicine, Cardiff University School of Medicine, Wales Heart Research Institute, Heath Park, Cardiff CF14 4XN, UK. dayancm@cf.ac.uk.
authors.forename: Colin
authors.initials: C
authors.lastname: Dayan
authors.affiliation: Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PS, UK. alastair.hay@bristol.ac.uk.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
keywords: antibiotics; antimicrobial resistance; primary care; urinary tract infection