Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records

Objective Determine the association of incident antibiotic prescribing levels for common infections with infection-related complications and hospitalisations by comparing high with low prescribing general practitioner practices.Design retrospective cohort study Retrospective cohort study.Data source...

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Autores principales:	Matthew Sperrin, Darren M Ashcroft, Andrew White, Victoria Palin, Chirag Mistry, Tjeerd Pieter van Staa, Birgitta van Bodegraven, William Welfare
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/624e42b431a54662b9624f4cc66cefb8
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spelling	oai:doaj.org-article:624e42b431a54662b9624f4cc66cefb82021-11-19T14:00:06ZInfection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records10.1136/bmjopen-2020-0412182044-6055https://doaj.org/article/624e42b431a54662b9624f4cc66cefb82021-01-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/1/e041218.fullhttps://doaj.org/toc/2044-6055Objective Determine the association of incident antibiotic prescribing levels for common infections with infection-related complications and hospitalisations by comparing high with low prescribing general practitioner practices.Design retrospective cohort study Retrospective cohort study.Data source UK primary care records from the Clinical Practice Research Datalink (CPRD GOLD) and SAIL Databank (SAIL) linked with Hospital Episode Statistics (HES) data, including 546 CPRD, 346 CPRD-HES and 338 SAIL-HES practices.Exposures Initial general practice visit for one of six common infections and the proportion of antibiotic prescribing in each practice.Main outcome measures Incidence of infection-related complications (as recorded in general practice) or infection-related hospital admission within 30 days after consultation for a common infection.Results A practice with 10.4% higher antibiotic prescribing (the IQR) was associated with a 5.7% lower rate of infection-related hospital admissions (adjusted analysis, 95% CI 3.3% to 8.0%). The association varied by infection with larger associations in hospital admissions with lower respiratory tract infection (16.1%; 95% CI 12.4% to 19.7%) and urinary tract infection (14.7%; 95% CI 7.6% to 21.1%) and smaller association in hospital admissions for upper respiratory tract infection (6.5%; 95% CI 3.5% to 9.5%) The association of antibiotic prescribing levels and hospital admission was largest in patients aged 18–39 years (8.6%; 95% CI 4.0% to 13.0%) and smallest in the elderly aged 75+ years (0.3%; 95% CI −3.4% to 3.9%).Conclusions There is an association between lower levels of practice level antibiotic prescribing and higher infection-related hospital admissions. Indiscriminately reducing antibiotic prescribing may lead to harm. Greater focus is needed to optimise antibiotic use by reducing inappropriate antibiotic prescribing and better targeting antibiotics to patients at high risk of infection-related complications.Matthew SperrinDarren M AshcroftAndrew WhiteVictoria PalinChirag MistryTjeerd Pieter van StaaBirgitta van BodegravenWilliam WelfareBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Matthew Sperrin Darren M Ashcroft Andrew White Victoria Palin Chirag Mistry Tjeerd Pieter van Staa Birgitta van Bodegraven William Welfare Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
description	Objective Determine the association of incident antibiotic prescribing levels for common infections with infection-related complications and hospitalisations by comparing high with low prescribing general practitioner practices.Design retrospective cohort study Retrospective cohort study.Data source UK primary care records from the Clinical Practice Research Datalink (CPRD GOLD) and SAIL Databank (SAIL) linked with Hospital Episode Statistics (HES) data, including 546 CPRD, 346 CPRD-HES and 338 SAIL-HES practices.Exposures Initial general practice visit for one of six common infections and the proportion of antibiotic prescribing in each practice.Main outcome measures Incidence of infection-related complications (as recorded in general practice) or infection-related hospital admission within 30 days after consultation for a common infection.Results A practice with 10.4% higher antibiotic prescribing (the IQR) was associated with a 5.7% lower rate of infection-related hospital admissions (adjusted analysis, 95% CI 3.3% to 8.0%). The association varied by infection with larger associations in hospital admissions with lower respiratory tract infection (16.1%; 95% CI 12.4% to 19.7%) and urinary tract infection (14.7%; 95% CI 7.6% to 21.1%) and smaller association in hospital admissions for upper respiratory tract infection (6.5%; 95% CI 3.5% to 9.5%) The association of antibiotic prescribing levels and hospital admission was largest in patients aged 18–39 years (8.6%; 95% CI 4.0% to 13.0%) and smallest in the elderly aged 75+ years (0.3%; 95% CI −3.4% to 3.9%).Conclusions There is an association between lower levels of practice level antibiotic prescribing and higher infection-related hospital admissions. Indiscriminately reducing antibiotic prescribing may lead to harm. Greater focus is needed to optimise antibiotic use by reducing inappropriate antibiotic prescribing and better targeting antibiotics to patients at high risk of infection-related complications.
format	article
author	Matthew Sperrin Darren M Ashcroft Andrew White Victoria Palin Chirag Mistry Tjeerd Pieter van Staa Birgitta van Bodegraven William Welfare
author_facet	Matthew Sperrin Darren M Ashcroft Andrew White Victoria Palin Chirag Mistry Tjeerd Pieter van Staa Birgitta van Bodegraven William Welfare
author_sort	Matthew Sperrin
title	Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
title_short	Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
title_full	Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
title_fullStr	Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
title_full_unstemmed	Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
title_sort	infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/624e42b431a54662b9624f4cc66cefb8
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Infection-related complications after common infection in association with new antibiotic prescribing in primary care: retrospective cohort study using linked electronic health records

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