New estimates of the burden of acute community-acquired infections among older people with diabetes mellitus: a retrospective cohort study using linked electronic health records
New estimates of the burden of acute community-acquired infections among older people with diabetes mellitus: a retrospective cohort study using linked electronic health records
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DOI：
10.1111/dme.12384
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发表时间：
2014-05-01
影响因子：
3.5
通讯作者：
Thomas, S. L.
中科院分区：
文献类型：
--
作者：
McDonald, H. I.;Nitsch, D.;Thomas, S. L.
目的描述急性社区获得性感染的发病率（下呼吸道感染、尿路感染和败血症），以及全因28天住院率和死亡率。方法我们使用来自临床实践研究数据链的电子初级保健记录，与死亡证明和医院事件统计入院数据相关联，结果218 805例老年糖尿病患者中，社区获得性感染负担较高，下呼吸道感染发病率最高（粗发病率：152.7/1000人-年），其次是尿路感染（男性和女性的粗发病率分别为51.4和147.9/1000人-年）。随着时间的推移，所有感染的发生率都在增加，这似乎是由人口年龄结构变化造成的。大多数诊断为肺炎和脓毒症的患者在同一天住院（分别为77.8%和75.1%）。对于下呼吸道感染和尿路感染，大部分28天的住院时间是在诊断当天之后（分别为39.1%和44.3%），并且有相当比例的患者（分别为7.1%和5.1%）因心血管疾病入院。发病后4周内，肺炎的全因死亡率为32.1（3115/9697），31.7%为脓毒症（780/2461），下呼吸道感染4.1%泌尿系感染占1.6%（1472/91574）.结论本大型队列研究提供了社区老年糖尿病患者中最新的详细感染发病率估计，随年龄、性别和地区以及时间的变化而变化。这应该有助于患者沟通风险和未来的医疗保健计划。
AimTo describe the incidence of acute community-acquired infections (lower respiratory tract infections, urinary tract infections and sepsis) among the UK population aged >= 65years with diabetes mellitus, and all-cause 28-day hospital admission rates and mortality.MethodsWe used electronic primary care records from the Clinical Practice Research Datalink, linked to death certificates and Hospital Episode Statistics admission data, to conduct a retrospective cohort study from 1997 to 2011.ResultsAmong the 218 805 older people with diabetes there was a high burden of community-acquired infection, lower respiratory tract infections having the highest incidence (crude rate: 152.7/1000person-years) followed by urinary tract infections (crude rates 51.4 and 147.9/1000 person-years for men and women, respectively). The incidence of all infections increased over time, which appeared to be driven by the population's changing age structure. Most patients diagnosed with pneumonia and sepsis were hospitalized on the same day (77.8 and 75.1%, respectively). For lower respiratory tract infections and urinary tract infections, a large proportion of 28-day hospitalizations were after the day of diagnosis (39.1 and 44.3%, respectively), and a notable proportion of patients (7.1 and 5.1%, respectively) were admitted for a cardiovascular condition. In the 4weeks after onset, all-cause mortality was 32.1% for pneumonia (3115/9697), 31.7% for sepsis (780/2461), 4.1% for lower respiratory tract infections (5685/139 301) and 1.6% for urinary tract infections (1472/91 574).ConclusionsThe present large cohort study provides up-to-date detailed infection incidence estimates among older people with diabetes in the community, with variation by age, sex and region and over time. This should be of use for patient communication of risk and future healthcare planning.