The relation between prescribing of different antibiotics and rates of mortality with sepsis in US adults.
Administration, Oral
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ administration & dosage
Death Certificates
Drug Prescriptions
Female
Humans
Insurance, Health
Male
Middle Aged
Penicillin Resistance
Penicillins
/ administration & dosage
Prevalence
Sepsis
/ drug therapy
United States
/ epidemiology
Young Adult
Antibiotics
Mortality
Penicillins
Sepsis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
22 Feb 2020
22 Feb 2020
Historique:
received:
02
08
2019
accepted:
18
02
2020
entrez:
24
2
2020
pubmed:
24
2
2020
medline:
6
5
2020
Statut:
epublish
Résumé
Antibiotic use contributes to the rates of sepsis and the associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on subsequent sepsis and sepsis-related mortality. We used a multivariable mixed-effects model to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2014 and 2015 to state-specific rates of mortality with sepsis (ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate) in different age groups of US adults between 2014 and 2015, adjusting for additional covariates and random effects associated with the ten US Health and Human Services (HHS) regions. Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual rates of mortality with sepsis of 0.95 (95% CI (0.02,1.88)) per 100,000 persons aged 75-84y, and of 2.97 (0.72,5.22) per 100,000 persons aged 85 + y. Additionally, the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American were associated with rates of mortality with sepsis in the corresponding age groups. Our results suggest that prescribing of penicillins is associated with rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of different syndromes should be considered with the aim of reducing the rates of severe outcomes, including mortality related to bacterial infections.
Sections du résumé
BACKGROUND
BACKGROUND
Antibiotic use contributes to the rates of sepsis and the associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on subsequent sepsis and sepsis-related mortality.
METHODS
METHODS
We used a multivariable mixed-effects model to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2014 and 2015 to state-specific rates of mortality with sepsis (ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate) in different age groups of US adults between 2014 and 2015, adjusting for additional covariates and random effects associated with the ten US Health and Human Services (HHS) regions.
RESULTS
RESULTS
Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual rates of mortality with sepsis of 0.95 (95% CI (0.02,1.88)) per 100,000 persons aged 75-84y, and of 2.97 (0.72,5.22) per 100,000 persons aged 85 + y. Additionally, the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American were associated with rates of mortality with sepsis in the corresponding age groups.
CONCLUSIONS
CONCLUSIONS
Our results suggest that prescribing of penicillins is associated with rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of different syndromes should be considered with the aim of reducing the rates of severe outcomes, including mortality related to bacterial infections.
Identifiants
pubmed: 32087679
doi: 10.1186/s12879-020-4901-7
pii: 10.1186/s12879-020-4901-7
pmc: PMC7036250
doi:
Substances chimiques
Anti-Bacterial Agents
0
Penicillins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
169Subventions
Organisme : NIGMS NIH HHS
ID : U54 GM088558
Pays : United States
Organisme : NIGMS NIH HHS
ID : U54GM088558
Pays : United States
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