Cited by 1,262Antibiotic Use and ResistanceAntibiotic Resistance in BacteriaPharmaceutical and Antibiotic Environmental Impacts

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A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance

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Bell, Brian G, Schellevis, Francois, Stobberingh, Ellen, Goossens, Herman, Pringle, Mike·2014·BMC Infectious Diseases

DOI 10.1186/1471-2334-14-13PMC PMC3897982

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Abstract

BACKGROUND: Greater use of antibiotics during the past 50 years has exerted selective pressure on susceptible bacteria and may have favoured the survival of resistant strains. Existing information on antibiotic resistance patterns from pathogens circulating among community-based patients is substantially less than from hospitalized patients on whom guidelines are often based. We therefore chose to assess the relationship between the antibiotic resistance pattern of bacteria circulating in the community and the consumption of antibiotics in the community. METHODS: Both gray literature and published scientific literature in English and other European languages was examined. Multiple regression analysis was used to analyse whether studies found a positive relationship between antibiotic consumption and resistance. A subsequent meta-analysis and meta-regression was conducted for studies for which a common effect size measure (odds ratio) could be calculated. RESULTS: Electronic searches identified 974 studies but only 243 studies were considered eligible for inclusion by the two independent reviewers who extracted the data. A binomial test revealed a positive relationship between antibiotic consumption and resistance (p < .001) but multiple regression modelling did not produce any significant predictors of study outcome. The meta-analysis generated a significant pooled odds ratio of 2.3 (95% confidence interval 2.2 to 2.5) with a meta-regression producing several significant predictors (F(10,77) = 5.82, p < .01). Countries in southern Europe produced a stronger link between consumption and resistance than other regions. CONCLUSIONS: Using a large set of studies we found that antibiotic consumption is associated with the development of antibiotic resistance. A subsequent meta-analysis, with a subsample of the studies, generated several significant predictors. Countries in southern Europe produced a stronger link between consumption and resistance than other regions so efforts at reducing antibiotic consumption may need to be strengthened in this area. Increased consumption of antibiotics may not only produce greater resistance at the individual patient level but may also produce greater resistance at the community, country, and regional levels, which can harm individual patients.

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Figure 1 How studies were selected.CC BY · PubMed Central

Figure 2 Forest plot showing odds ratio and 95% confidence interval for each study along with study weight.CC BY · PubMed Central

Figure 3 Funnel plot showing effect size (odds ratio) as a function of sample size (natural log of standard error).CC BY · PubMed Central

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Self-citation

Authors: Bell, B. G., Schellevis, F., Stobberingh, E., Goossens, H., & Pringle, M.
Affiliations: University of Nottingham (GB)
Maastricht University (NL)
University of Antwerp (BE)
Corresponding author: Bell, Brian G
ORCID: Bell, Brian G
Goossens, Herman
Venue: BMC Infectious Diseases
Publisher: Springer Science and Business Media LLC
Published: 2014-01-09
Volume: 14
Issue: 1
Pages: 13-13
ISSN: 1471-2334 (ISSN-L)
DOI: 10.1186/1471-2334-14-13
PMC: PMC3897982
OpenAlex: W2064618548
Cited by: 1,262
References: 223
Citations by year: 2026: 56 · 2025: 91 · 2024: 151 · 2023: 151 · 2022: 149 · 2021: 156 · 2020: 158 · 2019: 105 · 2018: 93 · 2017: 60 · 2016: 50 · 2015: 27 · 2014: 13
FWCI: 7.04
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: BMC Infectious Diseases (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by)
Pure Amsterdam UMC (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: European Commission (223083)
Topics: Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
Keywords: antibiotic use, antibiotic resistance, community-acquired infections, antimicrobial resistance patterns, selection pressure, Southern Europe, regional variation in resistance
MeSH terms: Anti-Bacterial Agents, Drug Resistance, Microbial, Europe, Humans, Odds Ratio

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A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance

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