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Meta-Analysis
. 2017 Aug 1;65(3):371-382.
doi: 10.1093/cid/cix233.

Implications of Antibiotic Resistance for Patients' Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis

Oliver van Hecke  1 , Kay Wang  1 , Joseph J Lee  1 , Nia W Roberts  2 , Chris C Butler  1
Affiliations
Meta-Analysis

Implications of Antibiotic Resistance for Patients' Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis

Oliver van Hecke et al. Clin Infect Dis. .

Abstract

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 that reported patient-level data on laboratory-confirmed infections (respiratory tract, urinary tract, skin or soft tissue), antibiotic resistance, and clinical outcomes. Our primary outcome was clinical response failure. Secondary outcomes were reconsultation, 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 (5659 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; n = 2432 participants), Streptococcus pneumoniae otitis media (OR = 2.51; 95% CI = 1.29-4.88; n = 921 participants), and S. pneumoniae community-acquired pneumonia (OR = 2.15; 95% CI = 1.32-3.51; n = 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 that matter to patients should inform more meaningful discussions between healthcare professionals and patients about antibiotic treatment for common infections.

Keywords: antibiotic resistance; clinical significance; primary care.

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Figures

Figure 1.
Figure 1.
Study selection. Abbreviation: RCT, randomized controlled trial.
Figure 2.
Figure 2.
Comparison between antibiotic-resistant and antibiotic-sensitive (Escherichia coli) urinary tract infections in relation to response failure. Odds ratio > 1 indicated higher odds of response failure in the presence of antibiotic-resistant infection. *indicates there was no agreement between susceptibility and treatment antibiotic, or the study did not report the type of antibiotic prescribed. Abbreviations: 3d, 3-day regimen; 5d, 5-day regimen; CI, confidence interval; OR, odds ratio.
Figure 3.
Figure 3.
Comparison between antibiotic-resistant and antibiotic-sensitive (Streptococcus pneumoniae) community-acquired pneumonia in relation to response failure. Odds ratio > 1 indicated higher odds of response failure in the presence of antibiotic-resistant infection. *indicates there was no agreement between susceptibility and treatment antibiotic, or the study did not report the type of antibiotic prescribed. Abbreviations: CI, confidence interval; OR, odds ratio.
Figure 4.
Figure 4.
Comparison between antibiotic-resistant and antibiotic-sensitive (Streptococcus pneumoniae) acute otitis media in relation to response failure. Odds ratio > 1 indicated higher odds of response failure in the presence of antibiotic-resistant infection. *indicates there was no agreement between susceptibility and treatment antibiotic, or the study did not report the type of antibiotic prescribed. Abbreviations: CI, confidence interval; OR, odds ratio.
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References

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