It is crucial to separate community-acquired from hospital-acquired infections since prevention and interventions to reduce the burden of drug-resistant infections in these two settings are largely different. It is also to critically decide on the allocation of resources for interventions and monitor the intervention’s effectiveness in the community and hospitals separately.

Overuse and misuse of antibiotics in the community may drive community-acquired AMR infections more than hospital-acquired AMR infections. Practices such as poor handwashing, poor hygiene or wastewater management, or high levels of antimicrobial drugs in wastewater, may expose people to an environmental source of AMR infections. Those communities are at higher risk of community-acquired AMR infections.

Overuse and misuse of antibiotics in hospitals tend to drive hospital-acquired AMR infections more than community-acquired AMR infections. People exposed to AMR bacteria in the hospital will be at higher risk of getting hospital-acquired AMR infections. For example, this can occur if hospital healthcare workers, patients, and relatives do not wash their hands frequently and adequately enough. However, it’s also possible for AMR bacteria acquired in hospitals to be transmitted to contacts in the community.

The treatment options and interventions for hospital-acquired and community-acquired infections are different as these infections are often associated with different microbes. To reduce the burden of community-acquired AMR infections, antibiotic stewardship, prevention, and intervention must focus on educating the community and the general population. On the other hand, to reduce the burden of hospital-acquired AMR infections, antibiotic stewardship, prevention, and intervention should focus on healthcare workers, patients, relatives, and the hospital environment. 

Doctors can sometimes determine whether a patient is likely to have a had community-acquired infection or a hospital-acquired infection using careful history taking and individual judgment. Nonetheless, for simplicity, a proxy definition is often used. For example, if microorganisms are isolated from clinical specimens (such as blood and urine) collected from patients at outpatient clinics or patients within two calendar days of their admission to hospital, these infections could be defined as community-acquired infections. If the patient gets sick or the microorganisms are isolated 3 or more days after admission, it is likely that the infection is hospital-acquired.

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