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

Abstract

ObjectiveDetermine 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 studyRetrospective cohort study.Data sourceUK 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.ExposuresInitial general practice visit for one of six common infections and the proportion of antibiotic prescribing in each practice.Main outcome measuresIncidence of infection-related complications (as recorded in general practice) or infection-related hospital admission within 30 days after consultation for a common infection.ResultsA 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%).ConclusionsThere 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.

Towards personalised anti-microbial and immune approaches to infections in acute care. Can real-time genomic-informed diagnosis of pathogens, and immune-focused therapies improve outcomes for patients? An observational, experimental study protocol

“…However, withholding antibiotics while awaiting definitive test results is also a risk for patients. A recent study of GP records in the UK suggested that practices with the lowest prescribing rates of antibiotics were associated with a higher rate of hospitalised infections [12].…”

Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation

“…Moreover, receiving antibiotics for empyema and parapneumonic effusion has been shown to reduce the likelihood of requiring surgical intervention by 43% compared to children who did not receive any pretreatment [13]. Compared to adults (i.e., aged 18-39 years), children are at greater risk of infection-related complications but not hospital admissions [31].…”

“…Findings from studies investigating multiple infection types are largely heterogenous. Van Bodegraven et al found that the prevalence of infection-related hospital admissions was negatively associated with practice-level antibiotic prescribing; specifically, a 10.4% increase in antibiotic prescribing was associated with a 5.7% decrease in the frequency of infection-related hospital admissions [31]. The magnitude of these associations varied according to infection type, with LRTIs showing the greatest reduction in infection-related hospital admissions, followed by UTIs and URTIs.…”

Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014–2019

“…This leaves important other parameters for the quality of antibiotic prescribing unconsidered, such as the use of recommended antibiotics for specific indications. Furthermore we cannot exclude that second and third line antibiotics have been prescribed to patients previously not responding to first line antibiotics or for patients at high risk of infection-related complications [42]. The quality indicators represent only relative values and compare the values within Germany.…”