School of Population Health and Environmental Sciences, King's College London, London, UK
NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals London, GreatMaze Pond, London, UK.
BMJ Open. 2020 Feb 28;10(2):e036975. doi: 10.1136/bmjopen-2020-036975.
This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates.
Cohort study.
706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017.
10.1 million registered patients with 69.3 million patient-years' follow-up.
All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications.
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.
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).
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.
本研究旨在评估在抗生素处方率较低的家庭诊所中，是否更频繁地出现严重细菌感染。
队列研究。
2002 年至 2017 年期间，英国临床实践研究数据链中的 706 家家庭诊所。
1010 万登记患者，6930 万患者就诊。
所有抗生素处方、急性和重复抗生素处方亚组，以及与特定编码指征相关的抗生素处方比例。
首次发生严重细菌感染。使用泊松模型进行拟合，调整年龄组、性别、合并症、贫困程度、地区和日历年份，使用随机截距表示家庭实践特定的估计值。
每 1000 患者就诊的标准化抗生素处方率从 2002 年（男性 423；女性 621）增加到 2012 年（男性 530；女性 842），然后在 2017 年下降到 449（男性）；女性 753）。中位数家庭实践的抗生素处方率为每 1000 患者就诊 648 次，不同实践的 95%范围为每 1000 患者就诊 430-1038 次抗生素处方。中位数家庭实践中，58%的抗生素处方记录了特定编码的指征，不同家庭实践的 95%范围为 10%-75%。共有 139759 例严重细菌感染首次发作。在调整了协变量和编码咨询的比例后，没有证据表明抗生素总处方率较高的家庭诊所发生严重细菌感染的频率较低。总抗生素处方增加 20%的调整后率比值为 1.03（95%CI 1.00 至 1.06，p=0.074）。
我们没有发现人群水平的证据表明，抗生素总处方率较低的家庭诊所总体上可能会更频繁地发生严重细菌感染。改善感染发作的记录有可能为初级保健中的更好的抗菌药物管理提供信息。
