van de Pol Alma C, Boeijen Josi A, Venekamp Roderick P, Platteel Tamara, Damoiseaux Roger A M J, Kortekaas Marlous F, van der Velden Alike W
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Antibiotics (Basel). 2021 Feb 18;10(2):196. doi: 10.3390/antibiotics10020196.
In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners' Network were followed from March through May 2019 ( = 389,708) and March through May 2020 ( = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference -8.0% (CI, -8.8 to -7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15-19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.
2020年，新冠疫情给全球初级卫生保健服务带来了巨大变化，可能改变了传染病诊疗次数和抗生素使用情况。我们旨在评估疫情对荷兰初级保健中感染情况及抗生素处方的影响。对朱利叶斯全科医生网络常规医疗保健数据库中纳入的所有患者进行随访，时间从2019年3月至5月（n = 389,708）以及2020年3月至5月（n = 405,688）。我们使用国际初级保健分类（ICPC）编码提取了呼吸道/耳部、泌尿道、胃肠道和皮肤感染的诊疗数据。这些诊疗被合并为疾病发作情况，并与抗生素处方相关联。计算并比较了2019年和2020年研究期间传染病发作次数（总数及使用抗生素治疗的次数）、并发症以及抗生素处方率（即使用抗生素治疗的发作次数比例）。与2019年同期相比，在疫情期间的几个月里，四种传染病实体以及肺炎、乳突炎和肾盂肾炎等并发症的发作次数均有所减少。胃肠道感染下降幅度最大（相对风险（RR）为0.54；置信区间（CI）为0.51至0.58），皮肤感染次之（RR为0.71；CI为0.67至0.75）。使用抗生素治疗的发作次数也有所下降，呼吸道/耳部感染下降幅度最大（RR为0.54；CI为0.52至0.58）。呼吸道/耳部感染的抗生素处方率从21%降至13%（差值为-8.0%（CI为-8.8至-7.2）），而其他传染病实体的处方率保持相似或略有上升。在第11周（封锁第一周）呼吸道/耳部感染出现初始高峰后，初级保健中传染病发作次数和抗生素使用的减少在第15 - 19周（新冠疫情中期）最为明显。总之，我们的研究结果表明，新冠疫情对荷兰初级保健中传染病发作情况和抗生素使用产生了深远影响。因此，使用抗生素治疗的传染病发作次数减少。我们没有发现并发症增加的证据。
