ArticlePloS one2019
Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: An ecological analysis.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it.
- One Health Determinants ofInternational journal of molecular sciences · 2023Pooled it
- Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution.The New England journal of medicine · 2020Trial
- Trial
- Network-based characterization of latent co-testing patterns in antimicrobial susceptibility testing.iScience · 2026Article
- Ecological context structures duplication and mobilization of antibiotic and metal resistance genes in bacteria.bioRxiv : the preprint server for biology · 2026Article
- Persistence of colistin-resistant Escherichia coli and the mcr-1 gene in the poultry chain, after the colistin ban.Veterinary research communications · 2025Article
- General practice antibiotic prescriptions attributable to respiratory syncytial virus by age and antibiotic class: an ecological analysis of the English population.The Journal of antimicrobial chemotherapy · 2025Article
- Antibiotic prescribing intensity and community UTI resistance: a cross-sectional ecological study.BJGP open · 2025Article
- Enhancing antimicrobial resistance surveillance and research: a systematic scoping review on the possibilities, yield and methods of data linkage studies.Antimicrobial resistance and infection control · 2025Article
- Characterization of enterotoxin, antibiotic resistance genes, and antimicrobial susceptibility profiling ofOpen veterinary journal · 2025Article
- Dynamic association of antimicrobial resistance in urinary isolates ofThe Lancet regional health. Europe · 2025Article
- Temporal Trends ofAntibiotics (Basel, Switzerland) · 2025Article
- Unlocking Nitrofurantoin: Understanding Molecular Mechanisms of Action and Resistance in Enterobacterales.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Review
- Geography, Antimicrobial Resistance, and Genomics ofMicroorganisms · 2024Article
- Recent approaches in computational modelling for controlling pathogen threats.Life science alliance · 2024Review
- Overcoming challenges in the economic evaluation of interventions to optimise antibiotic use.Communications medicine · 2024Review
- Antimicrobial Susceptibility and Characterization of Extended-Spectrum β-Lactamase-ProducingAntibiotics (Basel, Switzerland) · 2024Article
- Examining pharmacoepidemiology of antibiotic use and resistance in first-line antibiotics: a self-controlled case series study ofFrontiers in antibiotics · 2024Article
- Wastewater-Based Surveillance of Antimicrobial Resistance in Niger: An Exploratory Study.The American journal of tropical medicine and hygiene · 2023Article
- Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy.Infectious diseases and therapy · 2023Review
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundThe majority of studies that link antibiotic usage and resistance focus on simple associations between the resistance against a specific antibiotic and the use of that specific antibiotic. However, the relationship between antibiotic use and resistance is more complex. Here we evaluate selection and co-selection by assessing which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance to various antibiotics among Escherichia coli isolated from urinary samples.
methodsMonthly primary care prescribing data were obtained from National Health Service (NHS) Digital. Positive E. coli records from urine samples in English primary care (n = 888,207) between April 2014 and January 2016 were obtained from the Second Generation Surveillance System. Elastic net regularization was used to evaluate associations between prescribing of different antibiotic groups and resistance against amoxicillin, cephalexin, ciprofloxacin, co-amoxiclav and nitrofurantoin at the clinical commissioning group (CCG) level. England is divided into 209 CCGs, with each NHS practice prolonging to one CCG.
resultsAmoxicillin prescribing (measured in DDD/ 1000 inhabitants / day) was positively associated with amoxicillin (RR 1.03, 95% CI 1.01-1.04) and ciprofloxacin (RR 1.09, 95% CI 1.04-1.17) resistance. In contrast, nitrofurantoin prescribing was associated with lower levels of resistance to amoxicillin (RR 0.92, 95% CI 0.84-0.97). CCGs with higher levels of trimethoprim prescribing also had higher levels of ciprofloxacin resistance (RR 1.34, 95% CI 1.10-1.59).
conclusionAmoxicillin, which is mainly (and often unnecessarily) prescribed for respiratory tract infections is associated with increased resistance against various antibiotics among E. coli causing urinary tract infections. Our findings suggest that when predicting the potential impact of interventions on antibiotic resistances it is important to account for use of other antibiotics, including those typically used for other indications.
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