Exploring the relationship between primary care antibiotic prescribing for urinary tract infections, Escherichia coli bacteraemia incidence and antimicrobial resistance: an ecological study
Autor: | Rebecca Guy, Susan Hopkins, Céire Costelloe, Berit Muller-Pebody, Paul Aylin, Russell Hope, Alan P. Johnson, Alison Holmes, Hannah Lishman |
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Rok vydání: | 2017 |
Předmět: |
0301 basic medicine
Microbiology (medical) Adult medicine.medical_specialty 030106 microbiology Prevalence Bacteremia Drug resistance urologic and male genital diseases Trimethoprim 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine Drug Resistance Bacterial Escherichia coli Medicine Humans Pharmacology (medical) Blood culture 030212 general & internal medicine Longitudinal Studies Escherichia coli Infections Aged Aged 80 and over Antiinfective agent medicine.diagnostic_test Primary Health Care business.industry Incidence (epidemiology) Incidence General Medicine Middle Aged bacterial infections and mycoses Anti-Bacterial Agents Infectious Diseases England Nitrofurantoin Urinary Tract Infections Population study Female business medicine.drug |
Zdroj: | International journal of antimicrobial agents. 52(6) |
ISSN: | 1872-7913 |
Popis: | This study quantified the association between antibiotic prescribing for urinary tract infections (UTIs) and the incidence/antimicrobial susceptibility of UTI-related Escherichia coli bacteraemia in adult women in England. A national ecological study was conducted with data aggregated at GP practice level. The study population was adult female patients (18 years) with reported UTI-related E. coli bacteraemia in England (2012-2014). Reports of bacteraemia from the national mandatory surveillance scheme were linked with E. coli blood culture susceptibility data (where available) and the correlation with primary care exposure to trimethoprim and nitrofurantoin was quantified using longitudinal multilevel models. The study included 19 874 patients from 5916 practices. The overall incidence of UTI-related E. coli bacteraemia in the study group did not change significantly (1.3% increase, 95% CI 0.1-2.7%; P = 0.074). However, after adjusting for practice characteristics, UTI-related E. coli bacteraemia incidence increased by 3.0% (P0.001) and 1.5% (P0.01) with each increasing quintile in trimethoprim and nitrofurantoin prescribing, respectively. The incidence of trimethoprim-resistant bacteraemia increased by 4.5% (P = 0.032) with each increasing quintile in trimethoprim prescribing and was not associated with nitrofurantoin prescribing. This study demonstrated an association between GP prescribing for UTIs and UTI-related E. coli bacteraemia incidence at the practice level and showed that higher prescribing of trimethoprim is associated with higher incidence of trimethoprim-resistant bacteraemia. Evidence is provided of the importance of prudent antibiotic prescribing in primary care to prevent the development of antibiotic resistance, placing patients at risk of subsequent severe infections. |
Databáze: | OpenAIRE |
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