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: 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


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2020 Číslo 7

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