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The war against super-bacteria exposes older people to the risk of sepsis



The war with superbugs exposes the elderly to the risk of dying of sepsis, the experts warned.

GPs are under intense pressure to reduce the number of antibiotics they administer, to prevent infections from becoming resistant to treatment.

The NHS offers local health boards additional payments if they lower their prescribing rates, and doctors are in turn encouraged to give drugs to fewer patients.

GPs have been repeatedly told that they risk creating a "public health catastrophe" by distributing too much medicine – and in 2015, they were even warned that they could be struck off for overprescription.

A study published in the British Medical Journal suggests that this pressure endangers vulnerable people.

The results suggest that older adults (especially men over 85) should start taking antibiotics as soon as possible after diagnosis to prevent serious complications.

The results suggest that older adults (especially men over 85) should start taking antibiotics as soon as possible after diagnosis to prevent serious complications.

It reveals that antibiotics are regularly denied to the elderly, which increases the risk of sepsis by eight and doubles the risk of death.

The study contains the greatest recognition so far that the campaign against overuse of antibiotics could have unintended consequences disastrous.

The Royal College of General Practitioners welcomed the study, warning that family physicians are in an impossible position.

He added that GPs are "publicly perverse" for administering medications too easily, but that they know that non-compliance can be "a matter of life and death".

The new study, led by experts from Imperial College London, evaluated the medical records of 157,000 UK retirees diagnosed with UTIs between 2007 and 2015 – one of the most common reasons for prescription of antibiotics.

Academics discovered that 22,500 people – about 7% of the total – had not taken antibiotics at all.

And another 19,300 people – about 6% – had to return to their GP a second time before receiving a prescription, with a delay of seven days.

PATIENTS TAKE ANTIBIOTICS DURING TOO LONG

The researchers say that patients who manage to get a prescription for antibiotics receive them too long.

General practitioners often emit antibiotics longer than the time set by Public Health England.

Experts from Oxford University and the Faculties of Medicine of Brighton and Sussex examined the duration of the occurrence of antibiotics for 13 infections between 2013 and 2015.

Conditions included ear infections, sinusitis, sore throat, cough, bronchitis, pneumonia and cystitis.

Antibiotic treatments for upper respiratory infections, ear infections, coughs and bronchitis accounted for more than two-thirds of the total prescriptions.

According to the researchers, 80% or more of the treatments exceeded the recommendation recommendations, which are set at five days for most respiratory and ear infections.

More than half of the antibiotic prescriptions for cystitis in women also lasted longer than the recommended three days.

The researchers found that people who did not receive antibiotics had a risk of sepsis eight times higher than those who had been given antibiotics right away.

And they were twice as likely to die as a result.

Among those who had a late prescription – a common tactic used to reduce the use of antibiotics – the risk of sepsis was increased sevenfold and the risk of death increased by 16%.

The researchers estimated that for 37 patients not receiving antibiotics, there would be a case of sepsis that would not have been observed with immediate antibiotics.

The academics pointed out that even this increased risk remained low: those who had not been given antibiotics ran a risk of developing sepsis of 2.9%.

But they said that the pressure on the generalists is at the root of the problem.

"The question remains to know why a significant proportion – about 7% – of elderly, vulnerable patients have been diagnosed with urinary tract infection but have not received antibiotics," the academics wrote.

"This may be the choice of the patient or the physician, but it is also possible that antimicrobial management programs and the payment of quality premiums encourage a culture of more judicious use of antibiotics.

"Public Health England recently announced a 13.2% reduction in the number of antibiotics prescribed in primary care between 2013 and 2017." They added, "A decrease in the use of antibiotics can … harm vulnerable older populations who are already more likely to develop complications related to urinary tract infections and a blood infection.

"Our results suggest that general practitioners plan to prescribe antibiotics early for this vulnerable group of older adults because of their increased susceptibility to sepsis after urinary tract infection and despite increasing pressure to reduce the risk of developing sepsis." 39, inappropriate use of antibiotics. "

Professor Paul Aylin, author of the study, whose team work was funded by the NHS research group, said: "Although the prescription of antibiotics is controlled to help combat the growing problem of antibiotic resistance, our study suggests early use of antibiotics in elderly patients with urinary tract infection is the safest approach.

Professor Helen Stokes-Lampard, President of the Royal College of General Practitioners, said that family physicians are placed in an "extremely difficult position".

"We are under tremendous pressure not to prescribe – and publicly denigrated when we feel we are doing it too easily – and yet we know that in some cases, antibiotics are a matter of life and death," she said. she declared.

"Finding the right balance every time is extremely difficult." She acknowledged the "huge threat" of antibiotic resistance and said drugs are not a magic bullet for all diseases.

But she added, "Antibiotics are also important, life-saving drugs and it's essential that doctors do not be deterred from using them when they think it's appropriate to do so."

Experts have long warned that "antibiotic drugs" could deprive patients of vital treatments.

Professor Alan Johnson of Public Health England, who collaborated in the research, defended the desire to reduce the use of drugs.

"Antibiotic resistance is a major threat to public health due to the overconsumption of antibiotics," he said.

"Current recommendations suggest that health professionals consider a number of factors when deciding to prescribe antibiotics immediately or consider postponing antibiotic therapy in patients suspected of being infected with the urinary tract.

"This study highlights the importance of considering age when making clinical decisions about antibiotic prescribing to reduce the risk of complications.

"These works will help doctors more effectively target the use of antibiotics and improve the well-being of patients."

WHAT IS SEPSIS?

Sepsis occurs when the body reacts to an infection by attacking its own organs and tissues.

Some 44,000 people die each year from sepsis in the UK. Worldwide, someone dies of this condition every 3.5 seconds.

Sepsis has symptoms similar to those of influenza, gastroenteritis and pulmonary infection.

These included:

  • Sscrambled speech or confusion
  • Echills or muscle aches
  • Passing no urine in a day
  • Severe shortness of breath
  • Ido not feel like you die
  • Smarbled or discolored parent

The symptoms in children are:

  • Rapid breathing
  • Suitable or convulsions
  • Spotted, bluish or pale skin
  • Rashes that do not go away when you tap on them
  • Lethargy
  • Feeling abnormally cold

Children under five may vomit repeatedly, do not eat or do not urinate before 12 o'clock.

Anyone can develop sepsis, but it is more common in people who have recently undergone surgery, a urinary catheter or who have been in the hospital for a long time.

Other people at risk include people with weakened immune systems, chemotherapy patients, pregnant women, the elderly and the very young.

The treatment varies depending on the site of infection, but possibly involves antibiotics, intravenous solutions, and oxygen.

Source: UK Sepsis Trust and NHS choice


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