Patients receiving a high burden of antibiotics in the community in Spain: a cross‐sectional study

Abstract

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross‐sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient’s average age was 70 years; 52% were men; 60% smokers/ex‐smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty‐five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad‐spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study

“…Patients with chronic conditions, like those described in this study, deal with colonization, frequent infections and exacerbations, a high rate of Pseudomonas aeruginosa , and multidrug resistant bacteria [ 25 ]. These facts make them more susceptible to a poor prognosis and a higher probability of hospitalization and death regardless of COVID-19 [ 25 , 29 ].…”

“…Patients with chronic conditions, like those described in this study, deal with colonization, frequent infections and exacerbations, a high rate of Pseudomonas aeruginosa , and multidrug resistant bacteria [ 25 ]. These facts make them more susceptible to a poor prognosis and a higher probability of hospitalization and death regardless of COVID-19 [ 25 , 29 ]. The convergence of the threat of COVID-19 and antimicrobial resistance is a cocktail for devastating effects for this population [ 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

“…This may have helped to prevent exacerbations or worsening of their baseline situation. This would justify the fact that patients in the study who did not get COVID-19, showed a lower degree of hospitalization (21% vs. 30%) and mortality (3% vs. 6%) when compared to the same population group studied 3 years before the pandemic in the same setting [ 25 ].…”

“…Then, this supposed protective effect should be studied in patients who had been receiving macrolides continuously or cyclically for at least 3 months, before exposure to SARS-CoV-2. In clinical practice, patients receiving long courses of macrolides are characterized by their old age, underlying comorbidities and high morbidity and mortality rates [ 25 ]. The pandemic is having a higher impact on this population group, with a greater risk of worse outcomes.…”

Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomized clinical trial in primary care

“…2 More than 60% of adults presenting with acute rhinosinusitis, acute bronchitis or sore throat are prescribed an antibiotic. [2][3][4] It is well known that inappropriate antibiotic use has negative implications, including a risk of subsequent infection with resistant organisms, Clostridioides difficile infections, and adverse events. 5 Completion of an antibiotic treatment once initiated has classically been postulated.…”