#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002–2017: Population-based cohort study and decision analytic model


Autoři: Martin C. Gulliford aff001;  Judith Charlton aff001;  Joanne R. Winter aff001;  Xiaohui Sun aff001;  Emma Rezel-Potts aff001;  Catey Bunce aff001;  Robin Fox aff003;  Paul Little aff004;  Alastair D. Hay aff005;  Michael V. Moore aff004;  Mark Ashworth aff001
Působiště autorů: School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom aff001;  NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals London, London, United Kingdom aff002;  The Health Centre, Bicester, United Kingdom aff003;  Primary Care Research Group, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom aff004;  Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom aff005
Vyšlo v časopise: Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002–2017: Population-based cohort study and decision analytic model. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003202
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003202

Souhrn

Background

Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed.

Methods and findings

We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57–82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0–4 years old, the NNT was 29,773 (95% UI 18,458–71,091) in boys and 27,014 (16,739–65,709) in girls; over 85 years old, NNT was 262 (236–293) in men and 385 (352–421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55–64 years, the NNT was 247 (156–459) in men and 343 (234–556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65–74 years, the NNT following RTI was 1,257 (1,112–1,434) in men and 2,278 (1,966–2,686) in women; the NNT following skin infection was 503 (398–646) in men and 784 (602–1,051) in women; following UTI, the NNT was 121 (102–145) in men and 284 (241–342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period.

Conclusions

These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.

Klíčová slova:

Age groups – Antibiotics – Electronic medical records – Primary care – Respiratory infections – Sepsis – Skin infections – Urinary tract infections


Zdroje

1. Chan M. WHO Director-General addresses ministerial conference on antimicrobial resistance. Geneva: World Health Organization; 2016 [cited 2020 Jul 8]. Available from: https://www.who.int/dg/speeches/2016/antimicrobial-resistance-conference/en/.

2. Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR). Report 2018–2019. London: Public Health England; 2019 [cited 2020 Jul 8]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/843129/English_Surveillance_Programme_for_Antimicrobial_Utilisation_and_Resistance_2019.pdf.

3. Gulliford MC, Dregan A, Moore MV, Ashworth M, Staa T, McCann G, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014;4:e006245. doi: 10.1136/bmjopen-2014-006245 25348424

4. Ashworth M, Latinovic R, Charlton J, Cox K, Rowlands G, Gulliford M. Why has antibiotic prescribing for respiratory illness declined in primary care? A longitudinal study using the General Practice Research Database. J Public Health (Oxf). 2004;26:268–74.

5. Gulliford M, Latinovic R, Charlton J, Little P, van Staa T, Ashworth M. Selective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006. J Public Health (Oxf). 2009;31:512–20.

6. Aabenhus R, Hansen MP, Siersma V, Bjerrum L. Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database. Scand J Prim Health Care. 2017;35:162–9. doi: 10.1080/02813432.2017.1333321 28585886

7. Dolk FCK, Pouwels KB, Smith DRM, Robotham JV, Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrobial Chemotherapy. 2018;73(suppl_2):ii2–ii10. doi: 10.1093/jac/dkx504 29490062

8. Department of Health. UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health; 2013.

9. The Review on Antimicrobial Resistance by Jim O’Neill. Tackling drug-resistant infections globally: final report and recommendations. London: Review on antimicrobial resistance; 2016 [cited 2020 Jul 8]. Available from: https://amr-review.org/.

10. Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ. 2016;354:i3410. doi: 10.1136/bmj.i3410 27378578

11. Gulliford MC, Juszczyk D, Prevost AT, Soames J, McDermott L, Sultana K, et al. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Health Technol Assess. 2019;23(11):1–70. doi: 10.3310/hta23110 30900550

12. Cabral C, Lucas PJ, Ingram J, Hay AD, Horwood J. “It's safer to …” parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies. Soc Sci Med. 2015 [cited 2020 Jul 8];136–137:156–64. Available from: http://dx.doi.org/10.1016/j.socscimed.2015.05.027.

13. Lucas PJ, Cabral C, Hay AD, Horwood J. A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care. Scand J Prim Health Care. 2015;33:11–20. doi: 10.3109/02813432.2015.1001942 25716427

14. van den Broek d'Obrenan J, Verheij TJM, Numans ME, van der Velden AW. Antibiotic use in Dutch primary care: relation between diagnosis, consultation and treatment. J Antimicrobial Chemotherapy. 2014;69:1701–7. doi: 10.1093/jac/dku005 24508898

15. Lusini G, Lapi F, Sara B, Vannacci A, Mugelli A, Kragstrup J, et al. Antibiotic prescribing in paediatric populations: a comparison between Viareggio, Italy and Funen, Denmark. Eur J Public Health. 2009;19:434–8. doi: 10.1093/eurpub/ckp040 19349289

16. Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen J-A, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. The Lancet. 2016 [cited 2020 Jul 8];387:168–75. Available from: http://dx.doi.org/10.1016/S0140-6736(15)00474-2.

17. NHS England. Quality Premium: 2016/17 Guidance for CCGs. Leeds: NHS England; 2016 [cited 2020 Jun 1]. Available from: https://www.england.nhs.uk/wp-content/uploads/2016/03/qualty-prem-guid-2016-17.pdf.

18. NHS Choices. Sepsis. London: NHS; 2020 [cited 2020 Jul 8]. Available from: http://www.nhs.uk/Conditions/Blood-poisoning/Pages/Introduction.aspx.

19. National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management. NICE guideline [NG51]. London: NICE; 2017. Available from: https://www.nice.org.uk/guidance/ng51.

20. Royal College of Physicians. National Early Warning Score (NEWS) 2. London: Royal College of Physicians; 2017 [cited 2020 Jul 8]. Available from: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2.

21. The Lancet Respiratory Medicine. Crying wolf: the growing fatigue around sepsis alerts. Lancet Respiratory Medicine. 2018;6:161. doi: 10.1016/S2213-2600(18)30072-9 29508700

22. Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, et al. Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. 2015;44:827–36. doi: 10.1093/ije/dyv098 26050254

23. Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ. Validation and validity of diagnoses in the General Practice Research Database: a systematic review. Br J Clin Pharmacol. 2010;69:4–14. doi: 10.1111/j.1365-2125.2009.03537.x 20078607

24. Gulliford MC, Sun X, Charlton J, Winter JR, Bunce C, Boiko O et al. Serious bacterial infections and antibiotic prescribing in primary care. Cohort study using electronic health records in the UK. BMJ open. 2020;10:e036975. doi: 10.1136/bmjopen-2020-036975 32114481

25. Sun X, Gulliford M. Reducing antibiotic prescribing in primary care in England from 2014 to 2017: Population-based cohort study. BMJOpen. 2019;9:e023989. doi: 10.1136/bmjopen-2018-023989 31289049

26. Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age and Ageing. 2016;45:353–60. doi: 10.1093/ageing/afw039 26944937

27. Gafoor R, Charlton J, Ravindrarajah R, Gulliford MC. Importance of Frailty for Association of Antipsychotic Drug Use with Risk of Fracture: Cohort Study Using Electronic Health Records. J Am Med Dir Assoc. 2019;20:1495–1501.e1. doi: 10.1016/j.jamda.2019.05.009 31272856

28. Winter J, Charlton J, Ashworth M, Bunce C, Gulliford MC. Peritonsillar abscess and antibiotic prescribing for respiratory infection in primary care. Population-based cohort study and decision analytic model. Ann Fam Med. Forthcoming 2020.

29. Gelman A, Carlin JB, Stern HS, Rubin DB. Bayesian Data Analysis. 3rd ed. Boca Raton, FL: Chapman and Hall / CRC; 2013.

30. Rhee C, Murphy MV, Li L, Platt R, Klompas M. Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data. Clin Inf Dis 2015;60:88–95. doi: 10.1093/cid/ciu750 25258352

31. Balinskaite V, Bou-Antoun S, Johnson AP, Holmes A, Aylin P. An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis. Clinical Infectious Diseases. 2019;69:233–42. doi: 10.1093/cid/ciy904 30339254

32. Gharbi M, Drysdale JH, Lishman H, Goudie R, Molokhia M, Johnson AP, et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all-cause mortality: population-based cohort study. BMJ. 2019;364:l525. doi: 10.1136/bmj.l525 30814048


Článek vyšel v časopise

PLOS Medicine


2020 Číslo 7
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Hypertenze a hypercholesterolémie – synergický efekt léčby
nový kurz
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Multidisciplinární zkušenosti u pacientů s diabetem
Autoři: Prof. MUDr. Martin Haluzík, DrSc., prof. MUDr. Vojtěch Melenovský, CSc., prof. MUDr. Vladimír Tesař, DrSc.

Úloha kombinovaných preparátů v léčbě arteriální hypertenze
Autoři: prof. MUDr. Martin Haluzík, DrSc.

Halitóza
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Terapie roztroušené sklerózy v kostce
Autoři: MUDr. Dominika Šťastná, Ph.D.

Všechny kurzy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#