Löffler Christin, Altiner Attila, Diener Annette, Berner Reinhard, Feldmeier Gregor, Helbig Christian, Kern Winfried V, Köchling Anna, Schmid Michaela, Schön Gerhard, Schröder Helmut, Wegscheider Karl, Wollny Anja
Institute of General Practice, Rostock University Medical Center, 18057 Rostock, Germany.
Department of Pediatrics, University Hospital Carl Gustav Carus, TU, 01307 Dresden, Germany.
Antibiotics (Basel). 2020 Sep 29;9(10):653. doi: 10.3390/antibiotics9100653.
Acute respiratory tract infections (ARTI) are the main cause of inappropriate antibiotic prescribing. To date, there is limited evidence concerning whether low levels of antibiotic prescribing may impact patient safety. We investigate whether antibiotic prescribing for patients seeking primary care for ARTI correlates with the odds for hospitalization.
Analysis of patient baseline data ( = 3669) within a cluster-randomized controlled trial. Adult patients suffering from ARTI in German primary care are included. The main outcome measure is acute hospitalization for respiratory infection and for any acute disease from 0 to 42 days after initial consultation.
Neither the antibiotic status of individual patients (OR 0.91; 95% CI: 0.49 to 1.69; -value = 0.769) nor the physician-specific antibiotic prescription rates for ARTI (OR 1.22; 95% CI: 1.00 to 1.49; -value = 0.054) had a significant effect on hospitalization. The following factors increased the odds for hospitalization: patient's age, the ARTI being defined as lower respiratory tract infections (such as bronchitis) by the physician, the physician's perception of disease severity, and being cared for within group practices (versus treated in single-handed practices).
In a low-antibiotic-prescribing primary care setting such as Germany, lack of treatment with antibiotics for ARTI did not result in higher odds for hospitalization in an adult population.
急性呼吸道感染（ARTI）是抗生素不合理处方的主要原因。迄今为止，关于低水平抗生素处方是否会影响患者安全的证据有限。我们调查了因ARTI寻求初级医疗护理的患者的抗生素处方与住院几率之间是否存在关联。
对一项整群随机对照试验中的患者基线数据（n = 3669）进行分析。纳入德国初级医疗护理中患有ARTI的成年患者。主要结局指标是初次就诊后0至42天内因呼吸道感染和任何急性疾病而急性住院的情况。
个体患者的抗生素使用状况（比值比0.91；95%置信区间：0.49至1.69；P值 = 0.769）以及医生针对ARTI的特定抗生素处方率（比值比1.22；95%置信区间：1.00至1.49；P值 = 0.054）对住院均无显著影响。以下因素会增加住院几率：患者年龄、医生将ARTI定义为下呼吸道感染（如支气管炎）、医生对疾病严重程度的认知以及在集体诊所接受护理（相对于在单人诊所接受治疗）。
在德国这样抗生素处方率较低的初级医疗护理环境中，ARTI患者未接受抗生素治疗并未导致成年人群住院几率升高。
