Incidence, risk factors, and health service burden of sequelae of campylobacter and non-typhoidal salmonella infections in England, 2000–2015: A retrospective cohort study using linked electronic health records

Abstract

Background: Reactive arthritis, irritable bowel syndrome (IBS), Guillain-Barré syndrome, ulcerative colitis, and Crohn's disease may be sequelae of Campylobacter or non-typhoidal Salmonella (NTS) infections. Proton pump inhibitors (PPI) and antibiotics may increase the risk of gastrointestinal infections (GII); however, their impact on sequelae onset is unclear. We investigated the incidence of sequelae, their association with antibiotics and PPI prescription, and assessed the economic impact on the NHS. Methods: Data from the Clinical Practice Research Datalink for patients consulting their GP for Campylobacter or NTS infection, during 20 0 0-2015, were linked to hospital, mortality, and Index of Multiple Deprivation data. We estimated the incidence of sequelae and deaths in the 12 months following GII. We conducted logistic regression modelling for the adjusted association with prescriptions. We compared differences in resource use and costs pre-and post-infection amongst patients with and without sequelae. Findings: Of 20,471 patients with GII (Campylobacter 17,838), less than 2% (347) developed sequelae, with IBS (268) most common. Amongst Campylobacter patients, those with prescriptions for PPI within 12 months before and cephalosporins within 7-days before/after infection had elevated risk of IBS (adjusted odds ratio [aOR] 2.1, 1.5-2.9) and (aOR 3.6, 1.1-11.7) respectively. Campylobacter sequelae led to ∼ £1.3 million, (£750,0 0 0, £1.7 million) in additional annual NHS expenditure. Interpretation: Sequelae of Campylobacter and NTS infections are rare but associated with increased NHS costs. Prior prescription of PPI may be a modifiable risk factor. Incidence of sequelae, healthcare resource use and costs are essential parameters for future burden of disease studies.

Proton pump inhibitors use and risk of inflammatory bowel diseases: a meta-analysis of observational studies

“…There were 157,758 participants totally from which 12435 IBD events occurred after exposure to PPIs irrespective of age and gender. The studies were performed in the United Kingdom [ 17 ], USA (n=2) [ 18 , 19 ], The Netherlands (n=3) [ 7 , 20 , 23 ], Spain [ 21 ] and Denmark [ 22 ]. One retrospective database cohort study by Esan et al [ 17 ] assessed the sequelae of Campylobacter and Campylobacter and Non-typhoidal Salmonella infections followed from 2000–2015 and reported 27 UC and 10 CD cases among 15806 PPI users.…”

“…Six of our studies were graded as "good" [9,[18][19][20]22,23] quality evidence with a score ranging from 22-23 out of 28. One study was "excellent" [17] with a score of 24 and another study was deemed "fair" [21] with a score of 17. The included studies differed in their score due to the variation in methodology, sample size, duration of the study, confounding factor, study setting, and exposure to PPIs.…”

Electronic Health Record Network Research in Infectious Diseases

“…Within the field of infectious diseases, studies performed in the pre-COVID-19 era using EHR networks offer a glimpse of the potential benefits of EHR-based research. One study from the United Kingdom by Esan et al 72 evaluated the total burden of Campylobacter and nontyphoidal Salmonella infections within the National Health Service (NHS) by evaluating data from the Clinical Practice Research Datalink (CRPD). 72 The CRPD is an EHR data warehouse that consists of all outpatient primary care encounters within the NHS.…”

“…One study from the United Kingdom by Esan et al 72 evaluated the total burden of Campylobacter and nontyphoidal Salmonella infections within the National Health Service (NHS) by evaluating data from the Clinical Practice Research Datalink (CRPD). 72 The CRPD is an EHR data warehouse that consists of all outpatient primary care encounters within the NHS. CRPD data contain demographic information and specific encounter-level data associated with International Classification of Diseases, Ninth Revision (ICD-9)and ICD-10 diagnosis codes and are linked to inpatient hospital encounter data, mortality records, and socioeconomic status.…”

Predicting Hospital Readmission for Campylobacteriosis from Electronic Health Records: A Machine Learning and Text Mining Perspective

“…Complications associated with Campylobacter infection often require hospitalisation [21][22][23], and in England and Wales approximately 10% of reported cases were admitted to hospital for treatment [24]. In an Australian provincial setting, the average anunual rate of Campylobacter-associated hospital admissions was 13.6%, and the readmission rate of Campylobacter-associated hospitalizaiton was 5.53% whthin 28 days after discharge [25].…”