Abstract:
OBJECTIVE:Determine the association of incident antibiotic prescribing levels for common infections with infection-related complications and hospitalisations by comparing high with low prescribing general practitioner practices. DESIGN RETROSPECTIVE COHORT STUDY:Retrospective cohort study. DATA SOURCE:UK primary care records from the Clinical Practice Research Datalink (CPRD GOLD) and SAIL Databank (SAIL) linked with Hospital Episode Statistics (HES) data, including 546 CPRD, 346 CPRD-HES and 338 SAIL-HES practices. EXPOSURES:Initial general practice visit for one of six common infections and the proportion of antibiotic prescribing in each practice. MAIN OUTCOME MEASURES:Incidence of infection-related complications (as recorded in general practice) or infection-related hospital admission within 30 days after consultation for a common infection. RESULTS:A practice with 10.4% higher antibiotic prescribing (the IQR) was associated with a 5.7% lower rate of infection-related hospital admissions (adjusted analysis, 95% CI 3.3% to 8.0%). The association varied by infection with larger associations in hospital admissions with lower respiratory tract infection (16.1%; 95% CI 12.4% to 19.7%) and urinary tract infection (14.7%; 95% CI 7.6% to 21.1%) and smaller association in hospital admissions for upper respiratory tract infection (6.5%; 95% CI 3.5% to 9.5%) The association of antibiotic prescribing levels and hospital admission was largest in patients aged 18-39 years (8.6%; 95% CI 4.0% to 13.0%) and smallest in the elderly aged 75+ years (0.3%; 95% CI -3.4% to 3.9%). CONCLUSIONS:There is an association between lower levels of practice level antibiotic prescribing and higher infection-related hospital admissions. Indiscriminately reducing antibiotic prescribing may lead to harm. Greater focus is needed to optimise antibiotic use by reducing inappropriate antibiotic prescribing and better targeting antibiotics to patients at high risk of infection-related complications.
journal_name
BMJ Openjournal_title
BMJ openauthors
van Bodegraven B,Palin V,Mistry C,Sperrin M,White A,Welfare W,Ashcroft DM,van Staa TPdoi
10.1136/bmjopen-2020-041218subject
Has Abstractpub_date
2021-01-15 00:00:00pages
e041218issue
1issn
2044-6055pii
bmjopen-2020-041218journal_volume
11pub_type
杂志文章相关文献
BMJ Open文献大全abstract:INTRODUCTION:Obesity is a global pandemic that affects all socioeconomic strata, however, the highest figures have been observed in the most disadvantaged social groups. Evidence from the USA and Canada showed that specific urban settings encourage obesogenic behaviour in the population living and/or working there. We ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-018701
更新日期:2018-02-22 00:00:00
abstract:INTRODUCTION:An outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was reported in Wuhan, China, in mid-December 2019, and declared a pandemic by the WHO on 11 March 2020. Due to the unknown nature of the disease and the lack of specific drugs, several potential treatments were used for patients. ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-039730
更新日期:2020-07-31 00:00:00
abstract:INTRODUCTION:Reduced hip abductor strength may indirectly lead to changes in knee kinematics and functional impairment and has been reported in patients with patellofemoral pain and knee osteoarthritis (OA). Limited information is available regarding hip abductor strength following total or unicompartmental knee arthro...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-038770
更新日期:2020-08-13 00:00:00
abstract:INTRODUCTION:Cardiovascular disease (CVD) and cancer are leading causes of death globally. Early detection of cancer and risk factors for CVD may improve health outcomes and reduce mortality. General practitioners (GPs) are accessed by the majority of the population and play a key role in the prevention and early detec...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001405
更新日期:2012-07-02 00:00:00
abstract:OBJECTIVES:Food insecurity is 'the limited or uncertain availability of nutritionally adequate, safe foods or inability to acquire foods in socially acceptable ways'. Majority of tuberculosis (TB) cases of resource-poor settings experience food insecurity, which impacts treatment adherence and outcomes. We aimed to det...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033798
更新日期:2020-02-28 00:00:00
abstract:INTRODUCTION:Health literacy research has focused predominantly on the adult population, and much less is understood about this concept from an adolescent perspective. The tools currently available to measure adolescent health literacy have been adapted from adult versions. This limits their applicability to young peop...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-039920
更新日期:2020-11-11 00:00:00
abstract:INTRODUCTION:Chronic pelvic pain (CPP) affects more than 1 million UK women with associated healthcare costs of £158 million annually. Current evidence supporting interventions when no underlying pathology is identified is very limited and treatment is frequently inadequate. Gabapentin (a GABA analogue) is efficacious ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2016-014924
更新日期:2018-01-31 00:00:00
abstract:OBJECTIVES:To assess variation in antibiotic prescribing practices among village doctors in a rural region of Shandong province, China. DESIGN, SETTING AND PARTICIPANTS:Almost all outpatient encounters at village clinics result in a prescription being issued. Prescriptions were collected over a 2.5-year period from 8 ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-036703
更新日期:2020-06-01 00:00:00
abstract:INTRODUCTION:Tobacco smoking is one of the leading causes of preventable death. This is not inevitable as tobacco control tools have become more powerful and more effective. Among these, warnings on cigarette packs have proven to be somewhat effective. Our objective is to increase the efficacy of antismoking warnings b...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-036166
更新日期:2020-06-28 00:00:00
abstract:INTRODUCTION:Cancer is one of the leading causes of death globally and many jurisdictions have developed population-based cancer screening programmes to reduce the public health burden of disease. However, screening participation remains suboptimal. Social media and other mobile health (mHealth) technologies are increa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-035411
更新日期:2020-02-05 00:00:00
abstract:INTRODUCTION:Recent studies suggest that endoplasmic reticulum stress may play a critical role in the pathogenesis of amyotrophic lateral sclerosis (ALS) through an altered regulation of the proteostasis, the cellular pathway-balancing protein synthesis and degradation. A key mechanism is thought to be the dephosphoryl...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2016-015434
更新日期:2017-08-11 00:00:00
abstract:INTRODUCTION:Type 2 diabetes (T2D) is a significant problem, and lifestyle modifications including self-management are important. We have developed a structured individual-based lifestyle education (SILE) programme for T2D. With attention now being paid to techniques to change behaviour, we recently developed a behavio...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2017-017838
更新日期:2017-10-24 00:00:00
abstract:OBJECTIVES:Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015067
更新日期:2017-03-21 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the frequency of select adverse childhood experiences (ACEs) among a sample of American Indian (AI) adults living with type 2 diabetes (T2D) and the associations between ACEs and self-rated physical and mental health. We also examined associations between sociocultu...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022265
更新日期:2018-09-19 00:00:00
abstract:OBJECTIVES:To assess acceptability and feasibility of trial processes and the Rehabilitation Training (ReTrain) intervention including an assessment of intervention fidelity. DESIGN:A two-group, assessor-blinded, randomised controlled trial with parallel mixed methods process and economic evaluations. SETTING:Communi...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-018409
更新日期:2018-02-15 00:00:00
abstract:OBJECTIVES:We previously demonstrated that a calcium channel blocker, azelnidipine, improves left ventricular relaxation in patients with hypertension and diastolic dysfunction in a multicentre, Clinical impact of Azelnidipine on Left VentricuLar diastolic function and OutComes in patients with hypertension (CALVLOC) t...
journal_title:BMJ open
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1136/bmjopen-2014-006136
更新日期:2014-09-30 00:00:00
abstract:OBJECTIVES:To assess the relation between the number of clinical trials conducted and respective new drug approvals in India and South Africa. DESIGN:Construction and analysis of a comprehensive database of completed randomised controlled clinical trials based on clinicaltrials.gov from 1 January 2005 to 31 December 2...
journal_title:BMJ open
pub_type: 杂志文章,meta分析
doi:10.1136/bmjopen-2014-007304
更新日期:2015-08-31 00:00:00
abstract:OBJECTIVES:The rate of falling among older citizens appears to vary across different countries, but the underlying aspects causing this variation are unexplained. We aim to describe between-country variation in falling and explore whether intrinsic fall risk factors can explain possible variation. DESIGN:Prospective s...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-015827
更新日期:2017-06-30 00:00:00
abstract:OBJECTIVE:The human leucocyte antigen-DO (HLA-DO) gene located in the HLA non-classical class-II region may play a role in treatment response to hepatitis C virus (HCV). This study was conducted to explore the role of single nucleotide polymorphisms (SNPs) in HLA-DO in responding to HCV therapy. SETTING:All patients w...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-019406
更新日期:2018-04-12 00:00:00
abstract:INTRODUCTION:One in five men is likely to receive a diagnosis of prostate cancer (PCa) by the age of 85 years. Men diagnosed with low-risk PCa may be eligible for active surveillance (AS) to monitor their cancer to ensure that any changes are discovered and responded to in a timely way. Communication of risk in this co...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-017372
更新日期:2017-10-05 00:00:00
abstract:INTRODUCTION:The first birth cohorts of women offered human papillomavirus (HPV) vaccination as girls are now entering cervical screening. However, there is no international consensus on how to screen HPV vaccinated women. These women are better protected against cervical cancer and could therefore be offered less inte...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-020294
更新日期:2018-05-26 00:00:00
abstract:OBJECTIVE:We aimed at summarising rates and factors associated with retention in HIV care prior to antiretroviral treatment (ART) eligibility in sub-Saharan Africa. DESIGN:We conducted a systematic literature review (2002-2014). We searched Medline/Pubmed, Scopus and Web of Science, as well as proceedings of conferenc...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2014-006927
更新日期:2015-06-24 00:00:00
abstract:OBJECTIVES:The presentation of decrease blood pressure with tachycardia is usually an indicator of significant blood loss. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the haemodynamic status of trauma patients. As an SBP lower than the H...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011072
更新日期:2016-06-21 00:00:00
abstract:OBJECTIVE:To complete an economic evaluation within a randomised controlled trial (RCT) comparing the use of an electronic discharge communication tool (eDCT) compared with usual care. SETTING:Patients being discharged from a single tertiary care centre's internal medicine Medical Teaching Units. PARTICIPANTS:Between...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2017-019139
更新日期:2017-12-14 00:00:00
abstract:OBJECTIVE:To identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems. STUDY DESIGN:A scoping review was performed based on the methodology proposed by Arksey and O'Malley, and refined by Levac et al. Titles and abstracts were screened by two reviewers. A quant...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-041579
更新日期:2021-01-08 00:00:00
abstract:INTRODUCTION:Binge-eating disorder (BED) was included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An increasing number of treatment studies have been published, but an up-to-date comprehensive meta-analysis on diverse treatment approaches for B...
journal_title:BMJ open
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmjopen-2016-013655
更新日期:2017-03-29 00:00:00
abstract:OBJECTIVES:To determine the effectiveness of early assisted discharge for chronic obstructive pulmonary disease (COPD) exacerbations, with home care provided by generic community nurses, compared with usual hospital care. DESIGN:Prospective, randomised controlled and multicentre trial with 3-month follow-up. SETTING:...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001684
更新日期:2012-10-16 00:00:00
abstract:INTRODUCTION:There is an increasing need for the adoption of effective preschool obesity prevention interventions to combat the high levels of early-childhood obesity in the UK. This study will examine the feasibility and acceptability of the adapted version of the ToyBox intervention-a preschool obesity prevention pro...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-023707
更新日期:2018-10-27 00:00:00
abstract:OBJECTIVE:Many studies have suggested exposure to secondhand smoke (SHS) is a risk factor for various somatic diseases, but only few studies based on small sample size or specific groups have explored the association between passive smoking and mental distress. We performed this study to examine the relationship betwee...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011671
更新日期:2016-07-29 00:00:00
abstract:OBJECTIVES:To explore prescribing practitioners' perspectives on prescribed codeine use, their ability to identify dependence and their options for treatment in the UK. DESIGN:Cross-sectional design using a questionnaire containing closed-ended and open-ended items. SETTING:A nationally representative sample of presc...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011725
更新日期:2016-07-14 00:00:00