The use of large routine datasets to understand the epidemiology and management of common infections and antimicrobial resistance in primary care.
Doctoral thesis, UCL (University College London).
Infections are one of the most common reasons for patients to consult their doctor. Growing concern about antibiotic resistance has led to pressure on General Practitioners to reduce prescribing. There is a clear need to understand the epidemiology and management of infections in primary care. Routine datasets contain valuable information on infections, their management, hospitalisations and antimicrobial resistance but have been underutilised . In chapter one I give an overview of the history of antibiotics, the development of antimicrobial resistance and measures used to reduce prescribing in primary care. In chapter two I describe a systematic literature review showing how community antibiotic prescribing leads to antibiotic resistance. In chapter three I describe a data-linkage study showing strong relationships between recent GP antibiotic prescribing and the risk of antibiotic resistance in UTIs. In chapter four I describe analyses of the GPRD showing the burden of infection in primary care, frequent over-prescribing for minor respiratory tract infections, and high levels of consultation and prescribing in children, women and those living in socially deprived areas. In chapter five I describe an analysis of the GPRD showing that over 4000 patients with URTI (URTI), sore throat or otitis media need to be treated with antibiotics to prevent one serious complication. Only around 40 elderly people with chest infections, however, need treating to prevent one case of pneumonia. In chapter six I describe concerns about the emergence or community acquired MRSA and analyses of national HES data showing marked increases in hospitalisations for community onset staphylococcal disease. In chapter seven I summarise the conclusions from the research, reflect on the advantages and disadvantages of using large routinely available datasets for infectious disease research, describe the clinical and public health implications of the research and outline further research needs.
|Title:||The use of large routine datasets to understand the epidemiology and management of common infections and antimicrobial resistance in primary care|
|Additional information:||Authorisation for digitisation not received|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Infection and Immunity (Division of) > Research Department of Infection|
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