Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014.
Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014.
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DOI：
10.1371/journal.pone.0190521
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Butler CC
中科院分区：
文献类型：
--
作者：
Ahmed H;Farewell D;Jones HM;Francis NA;Paranjothy S;Butler CC
尿路感染（UTI）是老年人发病和使用抗生素的重要原因，但在初级保健中几乎没有描述疾病负担的数据。本研究的目的是估计临床诊断的尿路感染的发病率，并检查相关的经验性抗生素处方。我们进行了一项回顾性观察性研究，使用了近100万例年龄≥65岁的患者的相关健康记录，这些患者在英格兰的393个初级保健诊所注册。我们估计了2004年3月至2014年4月期间临床诊断的UTI的发病率，并使用多水平logistic回归分析了经验性抗生素处方的趋势。在931，945名老年人中，196，358人（21%）在研究期间至少有一次临床诊断的UTI。在男性中，65-74岁人群中每100人-年临床诊断的UTI发病率从2.81增加到3.05，75-84岁人群中从5.90增加到6.13，85岁以上人群中从8.08增加到10.54。在女性中，65-74岁的发病率从9.03增加到10.96，75-84岁的发病率从11.35增加到14.34，85岁以上的发病率从14.65增加到19.80。在研究期间，广谱抗生素的处方减少。老年男性（从45%增加到74%）和女性（从55%增加到82%）患有UTI的比例增加，处方UTI特异性抗生素。老年男性（42%至69%）和女性（15%至26%）在临床指南推荐的持续时间内使用抗生素的比例也有所增加。这是第一个描述UTI在英国初级保健中的负担的基于人群的研究。我们的研究结果表明，需要更好地了解临床诊断的尿路感染率增加的原因，并考虑如何最好地解决这一重要的临床问题。
Urinary tract infections (UTI) are an important cause of morbidity and antibiotic use in older adults but there are little data describing disease burden in primary care. The aim of this study was to estimate the incidence of clinically diagnosed UTI and examine associated empirical antibiotic prescribing. We conducted a retrospective observational study using linked health records from almost one million patients aged ≥65 years old, registered with 393 primary care practices in England. We estimated incidence of clinically diagnosed UTI between March 2004 and April 2014, and used multilevel logistic regression to examine trends in empiric antibiotic prescribing. Of 931,945 older adults, 196,358 (21%) had at least one clinically diagnosed UTI over the study period. In men, the incidence of clinically diagnosed UTI per 100 person-years at risk increased from 2.81 to 3.05 in those aged 65–74, 5.90 to 6.13 in those aged 75–84, and 8.08 to 10.54 in those aged 85+. In women, incidence increased from 9.03 to 10.96 in those aged 65–74, 11.35 to 14.34 in those aged 75–84, and 14.65 to 19.80 in those aged 85+. Prescribing of broad-spectrum antibiotics decreased over the study period. There were increases in the proportion of older men (from 45% to 74%) and women (from 55% to 82%) with UTI, prescribed a UTI specific antibiotic. There were also increases in the proportion of older men (42% to 69%) and women (15% to 26%) prescribed antibiotics for durations recommended by clinical guidelines. This is the first population-based study describing the burden of UTI in UK primary care. Our findings suggest a need to better understand reasons for increasing rates of clinically diagnosed UTI and consider how best to address this important clinical problem.
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影响因子：
3.7
作者：
Rossignol L;Pelat C;Lambert B;Flahault A;Chartier-Kastler E;Hanslik T
通讯作者：
Hanslik T
影响因子：
5.2
作者：
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通讯作者：
Hughes, Carmel
影响因子：
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作者：
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Thomas, S. L.
影响因子：
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影响因子：
4.2
作者：
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通讯作者：
Polgreen, Philip M.