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Community antibiotic consumption and acquired antibiotic resistance

November, 2019

An evaluation of the association between acquired antibiotic resistance and neighbourhood antibiotic use 1


The development of antibiotic resistance and its spread within a community setting is not well understood. In particular, it is still not known whether an increased use of antibiotics in a community increases the risk of acquiring individual antibiotic resistance independent of a history of antibiotic consumption.


A population-based case-control study was conducted in Israel to understand the association between neighbourhood fluoroquinolone consumption and the probability of having fluoroquinolone-resistant (FQ-R) E. coli in urine cultures.

Key results

Increased risk of antibiotic resistance in individuals not consuming antibiotics:

High neighbourhood fluoroquinolone consumption was shown to be associated with an increased individual risk of developing antibiotic-resistant bacteria.
  • A significant increase in the risk of fluoroquinolone resistance was also seen in those patients not consuming fluoroquinolones.

Crowded conditions might facilitate physical contact and increase the transmission of resistant bacteria or antibiotic-resistance genes within the population.

Increased risk of antibiotic resistance for the entire community:

  • Increased neighbourhood use of antibiotics might pose a risk for those individuals living in the same community but not using antibiotics.
  • This risk might be small for an individual, but overall it contributes to the spread of antibiotic resistance at a population level.


This study provides a strong reminder that antimicrobial resistance is a public health issue that is not limited to antimicrobial use in the individual patient and reinforces the need for effective individual and community antimicrobial stewardship initiatives.


  1. Low M, et al. Association between urinary community-acquired fluoroquinolone-resistant Escherichia coli and neighbourhood antibiotic consumption: a population-based case-control study. Lancet Infect Dis. 2019;19(4):419‒428.

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