Risk of sepsis and benefit from antibiotics following a GP consultation for infection are more substantial among those who are older, frail or who have had a urinary tract infection, a study in PLoS Medicine has found
Researchers studied 35,244 first episodes of sepsis among patients in UK general practices between 2002 and 2017. They evaluated whether patients had consulted their GP and been prescribed antibiotics in the 30 days prior to the sepsis diagnosis.
They found that the probability of sepsis increased at older ages, but that the risk was lower if an antibiotic was prescribed. However, the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age; for people aged 85 years and over, the NNT was 262 for men and 385 for women, compared with an NNT of 29,773 and 27,014 for boys and girls aged 0–4 years, respectively.
For all ages, sepsis was more likely with increasing frailty and after urinary tract infections, compared with skin or respiratory tract infections.
Greater awareness of the risk of sepsis emerged at the same time as efforts to reduce the spread of antimicrobial resistance through improved antimicrobial stewardship, the authors explained.
“These [results] may be used in antimicrobial stewardship to identify groups of consultations at which reduction of antibiotic prescribing can be pursued more safely,” they added.
 Gulliford M, Charlton J, Winter J et al. Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002–2017: Population-based cohort study and decision analytic model. PLoS Med 2020;17(7):e1003202. doi: 10.1371/journal.pmed.1003202