From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections

Abstract

Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case–control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria–resistance pair studied is an important prerequisite to clarify the design of future studies.

Lack of knowledge and training about antibiotic resistance among community pharmacists in Bangladesh: a cross-sectional study

“…It is a growing burden on global health, leading to increased mortality and prolonged hospital stay, particularly among patients with hospital-acquired infections caused by gramnegative bacteria [9][10][11][12][13]. The misuse of antibiotics is a signi cant contributor to the development of antimicrobial resistance, making it a major public health concern [14][15][16][17][18]. However, public knowledge and awareness of antibiotic resistance are often limited, with low awareness of the de nition and appropriate use of antibiotics [19][20][21][22].…”