Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA.
Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA.
BMC Infect Dis. 2020 Feb 22;20(1):169. doi: 10.1186/s12879-020-4901-7.
Antibiotic use contributes to the rates of sepsis and the associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on subsequent sepsis and sepsis-related mortality.
We used a multivariable mixed-effects model to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2014 and 2015 to state-specific rates of mortality with sepsis (ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate) in different age groups of US adults between 2014 and 2015, adjusting for additional covariates and random effects associated with the ten US Health and Human Services (HHS) regions.
Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual rates of mortality with sepsis of 0.95 (95% CI (0.02,1.88)) per 100,000 persons aged 75-84y, and of 2.97 (0.72,5.22) per 100,000 persons aged 85 + y. Additionally, the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American were associated with rates of mortality with sepsis in the corresponding age groups.
Our results suggest that prescribing of penicillins is associated with rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of different syndromes should be considered with the aim of reducing the rates of severe outcomes, including mortality related to bacterial infections.
抗生素的使用导致了脓毒症的发病率和相关死亡率的上升，尤其是在抗生素治疗后未能清除耐药感染的情况下。与此同时，关于某些抗生素的处方与随后的脓毒症和脓毒症相关死亡率之间的关系的信息有限。
我们使用多变量混合效应模型，将 2014 年至 2015 年期间，美国各州居民口服氟喹诺酮类药物、青霉素类药物、大环内酯类药物和头孢菌素类药物的总体门诊处方率与 2014 年至 2015 年期间不同年龄段美国成年人的脓毒症死亡率（ICD-10 编码 A40-41 作为死亡证明上死亡的根本或促成原因）进行关联，调整了与美国 10 个卫生与公众服务（HHS）地区相关的其他协变量和随机效应。
每 1000 名州居民口服青霉素处方率每年增加 1 个剂量，与 75-84 岁人群中每年每 10 万人因脓毒症导致的死亡率增加 0.95（95%CI：0.02，1.88）相关，与 85 岁及以上人群中每年每 10 万人因脓毒症导致的死亡率增加 2.97（0.72，5.22）相关。此外，50-64 岁人群中没有医疗保险的比例以及 65-84 岁人群中非洲裔美国人的比例与相应年龄组中脓毒症死亡率相关。
我们的研究结果表明，在老年美国人群中，青霉素的使用与脓毒症死亡率相关。这些结果以及相关的流行病学数据表明，在治疗不同综合征时，应考虑替代某些抗生素，特别是青霉素，以降低严重后果的发生率，包括与细菌感染相关的死亡率。
