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Publication - Dr Hannah Thornton

    Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care

    a systematic review and meta-analysis

    Citation

    Bryce, A, Hay, AD, Lane, IF, Thornton, HV, Wootton, M & Costelloe, CE, 2016, ‘Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: a systematic review and meta-analysis’. BMJ, vol 352.

    Abstract

    Objectives
    To systematically review studies investigating prevalence of antibiotic resistance in Escherichia coli urinary tract infections (UTIs) in children and, where appropriate, meta-analyse the relationship between previous primary care prescribed antibiotics and resistance.

    Design and data analysis
    Systematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used primary care antibiotics in children, stratified by study country Organisation for Economic Co-operation and Development (OECD) status. Random-effects meta-analysis to quantify the association between previous primary care antibiotic exposure and resistance.

    Data sources
    Observational and experimental studies identified through Medline, Embase, Cochrane and ISI Web of Knowledge databases, searched for articles published up to October 2015.

    Eligibility criteria for selecting studies
    Studies were eligible if they investigated and reported resistance in community-acquired UTI in children aged between 0 to 17 years. Electronic searches using MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction.

    Results
    We found 58 observational studies investigating 77,783 E. coli urinary isolates. In OECD country studies, the pooled resistance prevalence to ampicillin was 53.4% (95% CI: 46.0 to 60.8%); trimethoprim 23.6% (13.9 to 32.3%); co-amoxiclav 8.2% (7.9 to 9.6%); ciprofloxacin 2.1% (0.8 to 4.4%); nitrofurantoin was the lowest at 1.3% (0.8 to 1.7%). Resistance in non-OECD country studies was significantly higher: ampicillin 79.8% (73.0 to 87.7%); co-amoxiclav 60.3% (40.9 to 79.0%); ciprofloxacin 26.8% (11.1 to 43.0%); and nitrofurantoin 17.0% (9.8 to 24.2%). We found evidence that urinary tract bacterial isolates from individual children with prior primary care antibiotic prescriptions were more likely to be resistant to antibiotics, and this increased risk may persist for up to 6 months (OR 13.23; 95% CI: 7.84 to 22.31).

    Conclusions
    Prevalence of resistance to commonly prescribed primary care antibiotics in E. coli UTIs in children is high, particularly in non-OECD countries, where one possible explanation is over-the-counter antibiotic availability. This could render some antibiotics ineffective as first-line UTI treatments. Routine primary care use of antibiotics contributes to antimicrobial resistance in children, which may persist for up to 6 months post-antibiotic prescription.

    PROSPERO Registration Number: CRD42014007565

    Full details in the University publications repository