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Population cohort study finds high levels of antibiotic use increase the chances of infection-related hospital admissions
- Source :
- BMC Medicine
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- Background Previous research reported that individuals prescribed antibiotics frequently develop antimicrobial resistance. The objective of this study was to evaluate whether frequent antibiotic use is associated with reduced hospital admissions for infection-related complications. Methods Population-based cohort study analysing electronic health records from primary care linked to hospital admission records. The study population included patients prescribed a systemic antibiotic, recent record of selected infections and no history of chronic obstructive pulmonary disease. Propensity-matched cohorts were identified based on quintiles of prior antibiotic use in 3 years before. Results A total of 1.8 million patients were included. Repeated antibiotic use was frequent. The highest rates of hospital admissions for infection-related complications were observed shortly after antibiotic start in all prior exposure quintiles. For patients with limited prior antibiotic use, rates then dropped quickly and substantially. In contrast, reductions over time were substantially less in patients with frequent prior antibiotic use, with rates remaining elevated over the following 6 months. In patients without comorbidity comparing the highest to lowest prior exposure quintiles in the Clinical Practice Research Databank, the IRRs were 1.18 [95% CI 0.90–1.55] in the first 3 days after prescription, 1.44 [95% CI 1.14–1.81] in the days 4–30 after and 3.22 [95% CI 2.29–4.53] in the 3–6 months after. Conclusions Repeated courses of antibiotics, although common practice, may have limited benefit and indicator of adverse outcomes. A potential mechanism is that antibiotics may cause dysbiosis (perturbations of intestinal microbiota), contributing to colonization with resistant bacteria. Antibiotics should be used judiciously and only periodically unless indicated. Antimicrobial stewardship should include activities focusing on the substantive number of patients who repeatedly but intermittently get antibiotics.
- Subjects :
- medicine.medical_specialty
Epidemiology
medicine.drug_class
Antibiotics
Large population
Effectiveness
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Antibiotic resistance
Internal medicine
medicine
Humans
030212 general & internal medicine
Antibiotic use
Probability
030504 nursing
business.industry
Infection-related complications
Population cohort
Primary care
Hospitals
Anti-Bacterial Agents
Hospitalization
Fundamentals and skills
0305 other medical science
business
Research Article
Subjects
Details
- ISSN :
- 14689618 and 13676539
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- Evidence Based Nursing
- Accession number :
- edsair.doi.dedup.....04c7af0b2536a89103407ba21d48582f