Comparing indicators of disease severity among patients presenting to hospital for urinary tract infections before and during the COVID-19 pandemic.

IF 3.7 Q2 INFECTIOUS DISEASES
JAC-Antimicrobial Resistance Pub Date : 2024-04-24 eCollection Date: 2024-04-01 DOI:10.1093/jacamr/dlae067
Selina Patel, Martin Gill, Andrew Hayward, Susan Hopkins, Andrew Copas, Laura Shallcross
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Abstract

Background: During the COVID-19 pandemic, patients may have delayed seeking healthcare for urinary tract infections (UTIs). This could have resulted in more severe presentation to hospital and different antibiotic usage.

Objectives: We explored evidence for such changes through existing national indicators of prescribing, and routine clinical data collected in the electronic health record (EHR).

Methods: We carried out a retrospective cohort study of patients presenting to two UK hospitals for UTIs, comparing two indicators of disease severity on admission before and during the pandemic: intravenous (IV) antibiotic use, and National Early Warning Score 2 (NEWS2). We developed regression models to estimate the effect of the pandemic on each outcome, adjusting for age, sex, ethnicity and index of multiple deprivation.

Results: During the pandemic, patients were less likely to present to hospital for UTI with NEWS2 of 0 or 1 [adjusted odds ratio (aOR): 0.66; 95% confidence interval (CI): 0.52-0.85] compared with before, more likely to present with score 2 (aOR: 1.52; 95% CI: 1.18-1.94), whereas the likelihood of presenting with a NEWS2 of >2 remained the same (aOR: 1.06; 95% CI: 0.87-1.29). We did not find evidence that this limited increase in disease severity resulted in changes to IV antibiotic use on admission (adjusted risk ratio: 1.02; 95% CI: 0.91-1.15).

Conclusions: There may have been a small increase in disease severity at hospital presentation for UTI during the pandemic, which can be detected using routine data and not through national indicators of prescribing. Further research is required to validate these findings and understand whether routine data could support a more nuanced understanding of local antimicrobial prescribing practices.

比较 COVID-19 大流行之前和期间因尿路感染而入院的患者的疾病严重程度指标。
背景:在 COVID-19 大流行期间,尿路感染 (UTI) 患者可能会延迟就医。这可能会导致患者病情更加严重并导致不同的抗生素使用情况:我们通过现有的国家处方指标和电子健康记录(EHR)中收集的常规临床数据来探究这种变化的证据:我们对在英国两家医院就诊的尿毒症患者进行了一项回顾性队列研究,比较了大流行之前和期间入院时疾病严重程度的两个指标:静脉注射(IV)抗生素使用情况和国家预警评分 2(NEWS2)。我们建立了回归模型来估计大流行对每种结果的影响,并对年龄、性别、种族和多重贫困指数进行了调整:与大流行之前相比,在大流行期间,NEWS2 为 0 或 1 的UTI 患者到医院就诊的几率较低[调整后的几率比 (aOR):0.66;95% 置信区间 (CI):0.52-0.85],NEWS2 为 2 的患者到医院就诊的几率较高 (aOR:1.52;95% CI:1.18-1.94),NEWS2>2 的患者到医院就诊的几率保持不变 (aOR:1.06;95% CI:0.87-1.29)。我们没有发现证据表明疾病严重程度的有限增加会导致入院时静脉注射抗生素的使用发生变化(调整风险比:1.02;95% CI:0.91-1.15):大流行期间,尿毒症患者入院时的疾病严重程度可能略有增加,但这可以通过常规数据而非国家处方指标检测出来。还需要进一步研究来验证这些发现,并了解常规数据是否有助于更细致地了解当地的抗菌药物处方实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
0.00%
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审稿时长
16 weeks
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