The relation between prescribing of different antibiotics and rates of mortality with sepsis in US adults

Abstract

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: 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 statespecific 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: 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: 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.

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Analysis of Multiple Causes of Death: A Review of Methods and Practices

“…Our review showed that infectious diseases are commonly assessed using multiple-cause methods, for example, to ascertain socio-demographic differentials, to identify associated health conditions, and to assess the impact of health interventions to inform targeted prevention strategies. 71 , 91 , 112 , 113 With new and emerging infectious diseases, multiple-cause data is crucial for descriptive epidemiology and for providing evidence to inform prevention strategies. Since the declaration of COVID-19 as a pandemic in March 2020, the WHO implemented rules for ascertaining when death was due to COVID-19 (i.e.…”

Analysis of multiple causes of death: a review of methods and practices

“…Our review showed that infectious diseases commonly assessed using multiple cause methods, for example, to ascertain socio-demographic differentials, to identify associated health conditions, and to assess the impact of health interventions to inform targeted prevention strategies. 71,86,108,109 With new and emerging infectious diseases, MC data is crucial for descriptive epidemiology and for providing evidence to inform prevention strategies. Since declaration of COVID-19 as a pandemic in March 2020, the WHO implemented rules for ascertaining when a death was due to COVID-19 (i.e.…”