Fahmi Ali, Yang Ya-Ting, Zhong Xiaomin, Pate Alexander, Sharma Anita, Watts Simon, Ashcroft Darren M, Goldacre Ben, MacKenna Brian, Massey Jon, Mehrkar Amir, Bacon Seb, McMillan Brian, Dark Paul, Hand Kieran, Palin Victoria, van Staa Tjeerd Pieter
Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester M13 9PL, UK.
Chadderton South Health Centre, Eaves Lane, Chadderton, Oldham, UK.
J R Soc Med. 2025 Apr;118(4):126-137. doi: 10.1177/01410768251328997. Epub 2025 Apr 3.
ObjectivesAntibiotics are effective in treating bacterial infections, but they carry the risks of antimicrobial resistance and effectiveness loss. This study aimed to assess whether antibiotics for common infections are prescribed in a risk-based manner and how this changed during the COVID-19 pandemic.DesignCohort study of common infections and antibiotic prescribing.SettingWith the approval of NHS England, we accessed pseudonymised patient-level electronic health records of primary care data from The Phoenix Partnership through OpenSAFELY.ParticipantsWe included adults registered at general practices in England with a record of common infection, including lower respiratory tract infection (LRTI), upper respiratory tract infections (URTI) and lower urinary tract infection (UTI), from January 2019 to March 2023. Patients with a record of COVID-19 were excluded.Main outcome measuresPatient-specific risks of infection-related hospital admission were estimated for each infection using risk prediction scores for patients who were not prescribed an antibiotic. The infection cohorts were then grouped into risk deciles, and probabilities of being prescribed an antibiotic were assessed.ResultsWe found 15,719,750 diagnoses of common infections. Of them, 450,215 (2.86%) were hospitalised in the 30 days after the diagnosis and 10,429,060 (66.34%) were prescribed an antibiotic. There were substantial differences in observed rates of hospital admissions between the lowest and highest risk deciles (25-fold difference in URTI). The probability of being prescribed an antibiotic for LRTI or UTI was unrelated to hospital admission risk, and that for URTI was weakly related to hospital admission risk. During the COVID-19 pandemic, the level of risk-based antibiotic prescribing reduced.ConclusionsThere is a need to better target antibiotics in primary care to patients with worse prognosis and strengthen treatment guidelines in personalisation of prescribing.
目标
抗生素在治疗细菌感染方面有效，但存在抗菌药物耐药性和有效性丧失的风险。本研究旨在评估常见感染的抗生素处方是否基于风险进行，以及在新冠疫情期间这一情况如何变化。
设计
对常见感染和抗生素处方进行队列研究。
设置
经英国国民健康服务体系（NHS）英格兰地区批准，我们通过OpenSAFELY从凤凰伙伴关系获取了初级保健数据中患者层面的匿名电子健康记录。
参与者
我们纳入了2019年1月至2023年3月在英格兰普通诊所注册且有常见感染记录的成年人，包括下呼吸道感染（LRTI）、上呼吸道感染（URTI）和下尿路感染（UTI）。有新冠记录的患者被排除。
主要结局指标
对于未开具抗生素的患者，使用风险预测评分估计每种感染的患者特异性感染相关住院风险。然后将感染队列分为风险十分位数组，并评估开具抗生素的概率。
结果
我们发现了15,719,750例常见感染诊断。其中，450,215例（2.86%）在诊断后30天内住院，10,429,060例（66.34%）开具了抗生素。最低和最高风险十分位数组之间观察到的住院率存在显著差异（URTI相差25倍）。LRTI或UTI开具抗生素的概率与住院风险无关，而URTI的概率与住院风险弱相关。在新冠疫情期间，基于风险的抗生素处方水平降低。
结论
有必要在初级保健中更好地将抗生素靶向预后较差的患者，并加强处方个性化的治疗指南。
