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Serious bacterial infections and antibiotic prescribing in primary care: Cohort study using electronic health records in the UK

Serious bacterial infections and antibiotic prescribing in primary care: Cohort study using electronic health records in the UK
Serious bacterial infections and antibiotic prescribing in primary care: Cohort study using electronic health records in the UK

Objective This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates. Design Cohort study. Setting 706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017. Participants 10.1 million registered patients with 69.3 million patient-years' follow-up. Exposures All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications. Main outcome measures First episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates. Results The age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430-1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074). Conclusions We did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.

diagnostic microbiology, primary care, respiratory infections, urinary tract infections
2044-6055
1-8
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
Sun, Xiaohui
f3be9982-679a-4a14-8ec8-bca9f18c4beb
Charlton, Judith
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Winter, Joanne R.
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Bunce, Catey
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Boiko, Olga
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Fox, Robin
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Little, Paul
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Moore, Michael
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Hay, Alastair D.
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Ashworth, Mark
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Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
Sun, Xiaohui
f3be9982-679a-4a14-8ec8-bca9f18c4beb
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Winter, Joanne R.
d8f98946-4965-48cb-b998-f2954344cc3f
Bunce, Catey
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Boiko, Olga
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Fox, Robin
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
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Hay, Alastair D.
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Ashworth, Mark
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Gulliford, Martin C., Sun, Xiaohui, Charlton, Judith, Winter, Joanne R., Bunce, Catey, Boiko, Olga, Fox, Robin, Little, Paul, Moore, Michael, Hay, Alastair D. and Ashworth, Mark (2020) Serious bacterial infections and antibiotic prescribing in primary care: Cohort study using electronic health records in the UK. BMJ Open, 10 (2), 1-8, [e036975]. (doi:10.1136/bmjopen-2020-036975).

Record type: Article

Abstract

Objective This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates. Design Cohort study. Setting 706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017. Participants 10.1 million registered patients with 69.3 million patient-years' follow-up. Exposures All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications. Main outcome measures First episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates. Results The age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430-1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074). Conclusions We did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.

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Accepted/In Press date: 3 February 2020
Published date: 28 February 2020
Additional Information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Keywords: diagnostic microbiology, primary care, respiratory infections, urinary tract infections

Identifiers

Local EPrints ID: 445723
URI: http://eprints.soton.ac.uk/id/eprint/445723
ISSN: 2044-6055
PURE UUID: 29128347-e317-4503-ab36-262ef97c70dd
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 06 Jan 2021 17:42
Last modified: 09 Jan 2022 03:18

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Contributors

Author: Martin C. Gulliford
Author: Xiaohui Sun
Author: Judith Charlton
Author: Joanne R. Winter
Author: Catey Bunce
Author: Olga Boiko
Author: Robin Fox
Author: Paul Little
Author: Michael Moore ORCID iD
Author: Alastair D. Hay
Author: Mark Ashworth

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