Dataset Information

Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study.

ABSTRACT: OBJECTIVES:To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs). DESIGN:Ecological time-trend analysis and a prospective cohort study. SETTING:Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January 2006 to January 2016. MAIN OUTCOME MEASURES:Ecological time-trend analysis: 10-year trend analyses of the incidence of URTIs, bacterial infections/complications and respiratory antibiotic use. Prospective cohort study: Incidence of bacterial complications following URTIs in antibiotic-exposed and non-exposed patients. RESULTS:The utilisation of respiratory tract antibiotics decreased by 22% from 2006 to 2015, but no increased trend for mastoiditis (p=0.0933), peritonsillar abscess (p=0.0544), invasive group A streptococcal disease (p=0.3991), orbital abscess (p=0.9637), extradural and subdural abscesses (p=0.4790) and pansinusitis (p=0.3971) was observed. For meningitis and acute ethmoidal sinusitis, a decrease in the numbers of infections from 2006 to 2015 was observed (p=0.0038 and p=0.0003, respectively), and for retropharyngeal and parapharyngeal abscesses, an increase was observed (p=0.0214). Bacterial complications following URTIs were uncommon in both antibiotic-exposed (less than 1.5 per 10 000 episodes) and non-exposed patients (less than 1.3 per 10 000 episodes) with the exception of peritonsillar abscess after tonsillitis (risk per 10 000 tonsillitis episodes: 32.4 and 41.1 in patients with no antibiotic treatment and patients treated with antibiotics, respectively). CONCLUSIONS:Bacterial complications following URTIs are rare, and antibiotics may lack protective effect in preventing bacterial complications. Analyses of routinely collected administrative healthcare data can provide valuable information on the number of URTIs, antibiotic use and bacterial complications to patients, prescribers and policy-makers.

SUBMITTER: Cars T

PROVIDER: S-EPMC5695332 | biostudies-other | 2017 Nov

REPOSITORIES: biostudies-other

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Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study.

Cars Thomas T Eriksson Irene I Granath Anna A Wettermark Björn B Hellman Jenny J Norman Christer C Ternhag Anders A

BMJ open 20171115 11

<h4>Objectives</h4>To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs).<h4>Design</h4>Ecological time-trend analysis and a prospective cohort study.<h4>Setting</h4>Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January 2006 to January 2016.<h4>Main outcome measures</h4 ...[more]

PMID: 29146635

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Project description:BackgroundThe risk and characteristics of upper respiratory tract (URT) bacterial infections (URT-BI) among HIV (+) patients is understudied. We analyzed factors associated with its occurrence and the spectrum of culturable pathogens among patients routinely followed at the HIV Out-Patient Clinic in Warsaw.MethodsAll HIV (+) patients with available URT swab culture were included into analyses. Patients were followed from the day of registration in the clinic until first positive URT swab culture or last clinical visit from January 1, 2007 to July 31, 2016. Cox proportional hazard models were used to identify factors associated with positive URT swabs culture (those with p<0.1 in univariate included into multivariable).ResultsIn total 474 patients were included into the analyses, 166 with culturable URT swab. In general, 416 (87.8%) patients were male, 342 (72.1%) were infected through MSM contact, 253 (53.4%) were on antiretroviral therapy. Median follow-up time was 3.4 (1.3-5.7) years, age 35.2 (30.6-42.6) years and CD4+ count 528 (400-685) cells/μl. The most common cultured bacteria were S. aureus (40.4%) and S. pyogenes (13.9%) (Table 1). Patients with culturable URT-BI were more likely to be MSM (68.5% vs 78.9%; p<0.016), have detectable viral load (20.9% vs 12.0%; p<0.0001) and CD4+ cell count <500 cells/μl (55.2% vs 39.0%; p = 0.003) (Table 2). In multivariate survival analyses detectable viral load (HR3.13; 95%Cl: 2.34-4.19) and MSM (1.63;1.09-2.42) were increasing, but older age (0.63;0.58-0.69, per 5 years older) and higher CD4+ count (0.90;0.85-0.95, per 100 cells/μl) decreasing the risk of culturable URT-BI (Table 2).ConclusionsCulturable URT-BI are common among HIV-positive patients with high CD4+ count. Similarly to general population most common cultured bacteria were S. aureus and S. pyogenes. Risk factors identified in multivariate survival analysis indicate that younger MSM patients with detectable HIV viral load are at highest risk. In clinical practice this group of patients requires special attention.

Project description:BackgroundGood knowledge and appropriate attitude and practice about antibiotic use and resistance among the general population, are significant contributors to minimize the development of antibiotic resistance. We aimed to study the knowledge, attitude, and practice (KAP) regarding antibiotic use, resistance to upper respiratory tract infections (URTI), and associated factors with KAP, among the population attending a mass gathering in India.MethodsA cross-sectional study was conducted in 2016 during a mass gathering held in Ujjain city of Central India. A self-administered, pre-tested questionnaire consisting of 28 questions was used to collect data on demographic characteristics, KAP related to antibiotic use, resistance, and URTI. Descriptive analyses were used to describe participants' responses. Participants were divided into poor or good knowledge and appropriate or inappropriate groups of attitude and practice. Multivariable logistic regression models were used to examine the associations between demographic characteristics, URTI knowledge, and each domain of KAP. All statistical analyses were performed using Stata 16.0. The significance level was set at 5%.ResultsA total of 1915 participants consented to participate (response rate 92.7%) with a mean age of 39.3 (±14.7). Complete data on socio-demographics were available for 1619 participants. Of these, 59% were male, and 61% had an education level below high school. Eighty-nine percent of participants had poor knowledge about URTI. A majority of the respondents defined antibiotics incorrectly (93%) and were classified as having poor knowledge (97%). Most of the participants (63%) could not mention any contributors to the irrational use of antibiotics. Appropriate attitudes were observed in 40% of participants, 87% denied to comply with the prescribed course of antibiotics and 88.5% had inappropriate responses for practice. Age of the respondent, sex, education, occupation, and knowledge about URTI, were the main factors associated with the KAP.ConclusionsKAP about antibiotic use and resistance among the general population in India was poor. Knowledge about URTI is strongly associated with KAP. Community interventions, i.e., educational campaigns, should be designed and implemented promptly considering the differences in demographics of the target audience.

Dataset Information

Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study.

Publications

Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study.

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