Institute for Applied Health Research, University of Birmingham, Birmingham, UK
Silverdale Medical Practice, Pendlebury Health Centre, Salford, UK.
BMJ Open. 2023 Sep 14;13(9):e070636. doi: 10.1136/bmjopen-2022-070636.
To describe the population presenting to out-of-hours primary care with insect bites, establish their clinical management and the factors associated with antibiotic prescribing.
An observational study using routinely collected data from a large out-of-hours database (BORD, Birmingham Out-of-hours general practice Research Database).
A large out-of-hour primary care provider in the Midlands region of England.
All patients presenting with insect bites between July 2013 and February 2020 were included comprising 5774 encounters.
This cohort was described, and a random subcohort was created for more detailed analysis which established the clinical features of the presenting insect bites. Logistic regression was used to model variables associated with antibiotic prescribing.
Of the 5641 encounters solely due to insect bites, 67.1% (95% CI 65.8% to 68.3%) were prescribed antibiotics. General practitioners were less likely to prescribe antibiotics than advanced nurse practitioners (60.5% vs 71.1%, p<0.001) and there was a decreasing trend in antibiotic prescribing as patient deprivation increased. Pain (OR 2.13, 95% CI 1.18 to 3.86), swelling (OR 2.88, 95% CI 1.52 to 5.46) and signs of spreading (OR 3.45, 95% CI 1.54 to 7.70) were associated with an increased frequency of antibiotic prescribing. Extrapolation of the findings give an estimated incidence of insect bite consultations in England of 1.5 million annually.
Two-thirds of the patients presenting to out-of-hours primary care with insect bites receive antibiotics. While some predictors of prescribing have been found, more research is required to understand the optimal use of antibiotics for this common presentation.
描述在非工作时间向初级保健机构就诊的昆虫叮咬人群，确定他们的临床管理方法和与抗生素处方相关的因素。
一项使用大型非工作时间数据库（BORD，伯明翰非工作时间全科医学研究数据库）中常规收集的数据进行的观察性研究。
英格兰中部地区一个大型非工作时间初级保健服务提供商。
所有在 2013 年 7 月至 2020 年 2 月期间因昆虫叮咬就诊的患者均包括在内，共涉及 5774 例就诊。
对该队列进行了描述，并创建了一个随机亚组进行更详细的分析，以确定就诊时昆虫叮咬的临床特征。使用逻辑回归对与抗生素处方相关的变量进行建模。
在因昆虫叮咬而就诊的 5641 例就诊中，67.1%（95%CI 65.8%至 68.3%）的患者开具了抗生素。全科医生开具抗生素的可能性低于高级执业护士（60.5%比 71.1%，p<0.001），随着患者贫困程度的增加，抗生素的开具呈下降趋势。疼痛（OR 2.13，95%CI 1.18 至 3.86）、肿胀（OR 2.88，95%CI 1.52 至 5.46）和扩散迹象（OR 3.45，95%CI 1.54 至 7.70）与抗生素处方频率增加相关。这些发现的推断结果表明，英格兰每年有 150 万例昆虫叮咬咨询。
三分之二在非工作时间向初级保健机构就诊的昆虫叮咬患者接受了抗生素治疗。虽然已经发现了一些处方的预测因素，但仍需要进一步研究，以了解这种常见表现形式抗生素的最佳使用方法。
