A Comprehensive Systematic Review of Antimicrobial Resistance in Community - Acquired Infections Managed in Primary Health Care
Abstract
Introduction: Antimicrobial resistance (AMR) in community-acquired infections presents a critical global health threat, disproportionately affecting primary healthcare settings where most antibiotics are prescribed. Despite two decades of stewardship efforts, antibiotic prescribing rates remain persistently high, and resistance patterns show alarming geographic and temporal trends. This systematic review synthesizes the current evidence on the prevalence, clinical impact, drivers, and management of AMR in community-acquired infections within primary care. Methods: We conducted a comprehensive systematic review following established guidelines. We screened studies based on predefined criteria focusing on community-acquired bacterial infections, primary healthcare settings, and AMR data. Data from 80 included studies were extracted across domains including study setting, pathogens, resistance methodologies, findings, associated factors, and intervention outcomes. Studies encompassed systematic reviews, randomized trials, observational studies, and quasi-experimental designs from diverse global regions. Results: AMR prevalence varies significantly by infection type and geography. In urinary tract infections (UTIs), E. coli resistance to ampicillin was 53.4% in OECD countries versus 79.8% in non-OECD countries. Ciprofloxacin resistance is rising in community-acquired UTIs (P=0.003). For respiratory tract infections, pneumococcal penicillin non-susceptibility reached 58% in some…
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