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@article{Gulliford:2020:10.1371/journal.pmed.1003202,
author = {Gulliford, MC and Charlton, J and Winter, JR and Sun, X and Rezel-Potts, E and Bunce, C and Fox, R and Little, P and Hay, AD and Moore, MV and Ashworth, M and SafeAB, Study Group},
doi = {10.1371/journal.pmed.1003202},
journal = {PLoS Med},
title = {Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002-2017: Population-based cohort study and decision analytic model.},
url = {http://dx.doi.org/10.1371/journal.pmed.1003202},
volume = {17},
year = {2020}
}

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TY  - JOUR
AB  - BACKGROUND: Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. METHODS AND FINDINGS: We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57-82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0-4 years old, the NNT was 29,773 (95% UI 18,458-71,091) in boys and 27,014 (16,739-65,709) in girls; over 85 years old, NNT was 262 (236-293) in men and 385 (352-421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55-64 years, the NNT was 247 (156-459) in men and 343 (234-556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65-74 years, the NNT following RTI was 1,257 (1,112-1,434) in men and 2,278 (1,966-2,686) in women; the NNT following skin infection was 503 (398-646) in men and 784 (602-1,051) in women; following UTI, the NNT was 121 (102-145) in men and 284 (241-342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently.
AU  - Gulliford,MC
AU  - Charlton,J
AU  - Winter,JR
AU  - Sun,X
AU  - Rezel-Potts,E
AU  - Bunce,C
AU  - Fox,R
AU  - Little,P
AU  - Hay,AD
AU  - Moore,MV
AU  - Ashworth,M
AU  - SafeAB,Study Group
DO  - 10.1371/journal.pmed.1003202
PY  - 2020///
TI  - Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002-2017: Population-based cohort study and decision analytic model.
T2  - PLoS Med
UR  - http://dx.doi.org/10.1371/journal.pmed.1003202
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32702001
VL  - 17
ER  -

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