Systematic Review of Global Patterns of Antibiotic Resistance in Community-Acquired Infections Over the Past Decade

Abstract

Background: Antibiotic resistance in community-acquired infections (CAIs) has emerged as a major global health challenge, diminishing the effectiveness of empirical antimicrobial therapies. Despite numerous regional investigations, a consolidated global assessment of resistance patterns over the past decade remains limited. Objective: This systematic review aimed to synthesize global evidence on antibiotic resistance trends among key bacterial pathogens responsible for CAIs from 2014 to 2024. Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library identified observational studies reporting quantitative resistance rates in community-acquired urinary, respiratory, and skin and soft tissue infections. Eligible studies were screened, data extracted on pathogen profiles and resistance patterns, and risk of bias assessed using Joanna Briggs Institute (JBI) appraisal tools. Results: Eight studies comprising 45,820 isolates met inclusion criteria. Uropathogenic Escherichia coli exhibited high resistance, with third-generation cephalosporin resistance ranging from 28% to 42%, and fluoroquinolone resistance surpassing 40% across multiple regions. Streptococcus pneumoniae demonstrated macrolide resistance at approximately 28%, while community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) prevalence ranged from 12% to 25%. Conclusion: Rising resistance trends in common CAIs underscore a critical need for strengthened global surveillance, optimized empirical guidelines, and expanded antimicrobial stewardship initiatives. Investment in rapid diagnostic strategies within community healthcare settings is essential to mitigate this growing threat