Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London SE1 1UL, UK.
J Antimicrob Chemother. 2018 Feb 1;73(2):287-296. doi: 10.1093/jac/dkx374.
Antibiotic use can have negative unintended consequences including disruption of the human microbiota, which is thought to protect against pathogen overgrowth. We conducted a systematic review to assess whether there is an association between exposure to antibiotics and subsequent risk of community-acquired infections.
We searched MEDLINE, EMBASE and Web of Science for studies published before 30 June 2017, examining the association between antibiotic use and subsequent community-acquired infection. Infections caused by Clostridium difficile and fungal organisms were excluded. Studies focusing exclusively on resistant organism infections were also excluded.
Eighteen of 22588 retrieved studies met the inclusion criteria. From these, 16 studies reported a statistically significant association between antibiotic exposure and subsequent risk of community-acquired infection. Infections associated with prior antibiotic use included Campylobacter jejuni infection (one study), recurrent furunculosis (one study), invasive Haemophilus influenzae type b infection (one study), infectious mastitis (one study), meningitis (one study), invasive pneumococcal disease (one study), Staphylococcus aureus skin infection (one study), typhoid fever (two studies), recurrent boils and abscesses (one study), upper respiratory tract infection and urinary tract infection (one study) and Salmonella infection (five studies), although in three studies on Salmonella infection the effect was of marginal statistical significance.
We found an association between prior antibiotic use and subsequent risk of a diverse range of community-acquired infections. Gastrointestinal and skin and soft tissue infections were most frequently found to be associated with prior antibiotic exposure. Our findings support the hypothesis that antibiotic use may predispose to future infection risk, including infections caused by both antibiotic-resistant and non-resistant organisms.
抗生素的使用可能会带来负面的意外后果，包括扰乱人体微生物群，而人体微生物群被认为可以防止病原体过度生长。我们进行了一项系统评价，以评估暴露于抗生素与随后发生社区获得性感染的风险之间是否存在关联。
我们检索了 MEDLINE、EMBASE 和 Web of Science，以获取截至 2017 年 6 月 30 日之前发表的研究，研究了抗生素使用与随后发生的社区获得性感染之间的关联。排除了艰难梭菌和真菌病原体引起的感染。专门研究耐药生物体感染的研究也被排除在外。
在 22588 篇检索到的研究中，有 18 篇符合纳入标准。其中 16 项研究报告了抗生素暴露与随后发生社区获得性感染风险之间存在统计学显著关联。与先前抗生素使用相关的感染包括空肠弯曲菌感染（一项研究）、复发性疖病（一项研究）、侵袭性流感嗜血杆菌 b 型感染（一项研究）、传染性乳腺炎（一项研究）、脑膜炎（一项研究）、侵袭性肺炎球菌病（一项研究）、金黄色葡萄球菌皮肤感染（一项研究）、伤寒（两项研究）、复发性痈和脓肿（一项研究）、上呼吸道感染和尿路感染（一项研究）和沙门氏菌感染（五项研究），尽管在三项关于沙门氏菌感染的研究中，这种关联具有边缘统计学意义。
我们发现先前使用抗生素与随后发生各种社区获得性感染的风险之间存在关联。胃肠道和皮肤软组织感染最常与先前的抗生素暴露相关。我们的研究结果支持这样一种假设，即抗生素的使用可能会导致未来的感染风险增加，包括由抗生素耐药和非耐药生物体引起的感染。
