The implications of antibiotic resistance for patients' recovery from common infections in the community: a systematic review and meta-analysis.
Van Hecke O., Wang K., Lee JJ., Roberts NW., Butler CC.
Background: Antibiotic use is the main driver for carriage of antibiotic-resistant bacteria. The perception exists that failure of antibiotic treatment due to antibiotic resistance has little clinical impact in the community. Methods: We searched MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials and Web of Science from inception to 15 April 2016 without language restriction. We included studies conducted in community settings which reported patient-level data on laboratory-confirmed infections (respiratory, urinary tract, skin or soft tissue), antibiotic resistance, and clinical outcomes. Our primary outcome was clinical response failure. Secondary outcomes were re-consultation, further antibiotic prescriptions, symptom duration and symptom severity. Where possible, we calculated odds ratios with 95% confidence intervals by performing meta-analysis using random effects models. Results: We included 26 studies (5,659 participants).Clinical response failure was significantly more likely in participants with antibiotic-resistant Escherichia coli urinary tract infections (odds ratio [OR] 4·19,95% confidence interval [CI] 3·27-5·37,2,432 participants),Streptococcus pneumoniae otitis media (OR 2·51,95% CI 1·29-4·88,921 participants),and Streptococcus pneumoniae community-acquired pneumonia (OR 2·15,95% CI 1·32-3·51,916 participants).Clinical heterogeneity precluded primary outcome meta-analysis for Staphylococcus aureus skin or soft tissue infections. Conclusions: Antibiotic resistance significantly impacts on patients' illness burden in the community. Patients with laboratory-confirmed antibiotic-resistant urinary and respiratory tract infections are more likely to experience delays in clinical recovery after treatment with antibiotics. A better grasp of the risk of antibiotic resistance on outcomes which matter to patients should inform more meaningful discussions between health care professionals and patients about antibiotic treatment for common infections.