Antibiotic resistance in urinary tract infections in a primary care cohort in East London (360G-Wellcome-206441_Z_17_Z)

Antimicrobial resistance (AMR) is an alarming global issue causing difficulties for individual patient management and health systems. Antimicrobial use and misuse is the main driver behind AMR, and prescribing interventions such as antimicrobial stewardship programmes are our our main defense against it. We currently have a limited understanding of who is at most risk and how specific prescribing patterns drive resistance. This PhD will build on the unique resource of the East London Data Linkage Project that has already linked primary and secondary care records across two Clinical Commissioning Groups, by establishing further linkages with microbiology data on resistance patterns across a highly diverse population of more than a million people. This will enable a broad range of analyses identifying how risk factors such as ethnicity, social deprivation, age, gender and co-morbidities affect prescribing patterns and resistance. It will allow individual-level analyses of how resistance is related to exposure of specific antibiotics, how prescribing of one antibiotic class may lead to co-selection of resistance in other antibiotic classes, and the temporal relationships between antibiotic exposure and resistance. Analyses will inform our scientific understanding of resistance, and also present opportunities for personalised prescribing based on individualised risk rather than area-based blanket antibiotic policies.