Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England:   results from the Bug Watch community cohort study

Catherine M. Smith; Laura J. Shallcross; Peter Dutey-Magni; Anne Conolly; Christopher Fuller; Suzanne Hill; Arnoupe Jhass; Franziska Marcheselli; Susan Michie; Jennifer S. Mindell; Matthew J. Ridd; Georgios Tsakos; Andrew C. Hayward; Ellen B. Fragaszy; Niall Anderson; Lou Atkins; Elise Crayton; Spiros Denaxas; Nadia Elsay; Gillian Forbes; Ellen Fragaszy; Nick Freemantle; Martin Gill; Rob Horne; Patty Kostkova; Fabiana Lorencatto; Michelle Richardson; John Robson; Patrick Rockenschaub; Claire Royston; Catherine M. Smith; Elizabeth Sutton; James Thomas; Carolyn Tarrant; Rosanna Traina; Emma Richardson; Jonathan West; Haydn Williams

doi:10.1186/s12879-021-05811-7

Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study

Catherine M. Smith, Laura J. Shallcross, Peter Dutey-Magni, Anne Conolly, Christopher Fuller, Suzanne Hill, Arnoupe Jhass, Franziska Marcheselli, Susan Michie, Jennifer S. Mindell, Matthew J. Ridd, Georgios Tsakos, Andrew C. Hayward, Ellen B. Fragaszy, Niall Anderson, Lou Atkins, Elise Crayton, Spiros Denaxas, Nadia Elsay, Gillian ForbesEllen Fragaszy, Nick Freemantle, Martin Gill, Rob Horne, Patty Kostkova, Fabiana Lorencatto, Michelle Richardson, John Robson, Patrick Rockenschaub, Claire Royston, Catherine M. Smith, Elizabeth Sutton, James Thomas, Carolyn Tarrant, Rosanna Traina, Emma Richardson, Jonathan West, Haydn Williams

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.

Original language	English
Article number	105
Journal	BMC Infectious Diseases
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12879-021-05811-7
Publication status	Published - 22 Jan 2021

Bibliographical note

Funding Information:
This work is supported by the Economic and Social Research Council, grant number ES/P008321/1, as part of the Preserving Antibiotics through Safe Stewardship (PASS) project. Professor Hayward is a National Institute for Health Research (NIHR) Senior Investigator. MJR is funded by an NIHR Post-Doctoral Research Fellowship (PDF-2014 − 07-013). LS is funded by a NIHR Clinician Scientist Award (CS-2016-16-007). AJ is funded as an NIHR In-Practice Fellow.

© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.

Keywords

Anti-Bacterial Agents/therapeutic use
Antimicrobial Stewardship
Cohort Studies
Delivery of Health Care
England/epidemiology
Female
Humans
Incidence
Infections/drug therapy
Male
Middle Aged
Referral and Consultation/statistics & numerical data
Surveys and Questionnaires
Syndrome

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10.1186/s12879-021-05811-7Licence: CC BY 3.0

Incidence, healthcare-seeking behaviours, antibiotic use and natural history
© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Final published version, 569 KBLicence: CC BY 3.0

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Smith, C. M., Shallcross, L. J., Dutey-Magni, P., Conolly, A., Fuller, C., Hill, S., Jhass, A., Marcheselli, F., Michie, S., Mindell, J. S., Ridd, M. J., Tsakos, G., Hayward, A. C., Fragaszy, E. B., Anderson, N., Atkins, L., Crayton, E., Denaxas, S., Elsay, N., ... Williams, H. (2021). Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study. BMC Infectious Diseases, 21(1), Article 105. https://doi.org/10.1186/s12879-021-05811-7

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title = "Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study",

abstract = "Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.",

keywords = "Anti-Bacterial Agents/therapeutic use, Antimicrobial Stewardship, Cohort Studies, Delivery of Health Care, England/epidemiology, Female, Humans, Incidence, Infections/drug therapy, Male, Middle Aged, Referral and Consultation/statistics & numerical data, Surveys and Questionnaires, Syndrome",

author = "Smith, {Catherine M.} and Shallcross, {Laura J.} and Peter Dutey-Magni and Anne Conolly and Christopher Fuller and Suzanne Hill and Arnoupe Jhass and Franziska Marcheselli and Susan Michie and Mindell, {Jennifer S.} and Ridd, {Matthew J.} and Georgios Tsakos and Hayward, {Andrew C.} and Fragaszy, {Ellen B.} and Niall Anderson and Lou Atkins and Elise Crayton and Spiros Denaxas and Nadia Elsay and Gillian Forbes and Ellen Fragaszy and Nick Freemantle and Martin Gill and Rob Horne and Patty Kostkova and Fabiana Lorencatto and Michelle Richardson and John Robson and Patrick Rockenschaub and Claire Royston and Smith, {Catherine M.} and Elizabeth Sutton and James Thomas and Carolyn Tarrant and Rosanna Traina and Emma Richardson and Jonathan West and Haydn Williams",

note = "Funding Information: This work is supported by the Economic and Social Research Council, grant number ES/P008321/1, as part of the Preserving Antibiotics through Safe Stewardship (PASS) project. Professor Hayward is a National Institute for Health Research (NIHR) Senior Investigator. MJR is funded by an NIHR Post-Doctoral Research Fellowship (PDF-2014 − 07-013). LS is funded by a NIHR Clinician Scientist Award (CS-2016-16-007). AJ is funded as an NIHR In-Practice Fellow. {\textcopyright} The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.",

year = "2021",

month = jan,

day = "22",

doi = "10.1186/s12879-021-05811-7",

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Smith, CM, Shallcross, LJ, Dutey-Magni, P, Conolly, A, Fuller, C, Hill, S, Jhass, A, Marcheselli, F, Michie, S, Mindell, JS, Ridd, MJ, Tsakos, G, Hayward, AC, Fragaszy, EB, Anderson, N, Atkins, L, Crayton, E, Denaxas, S, Elsay, N, Forbes, G, Fragaszy, E, Freemantle, N, Gill, M, Horne, R, Kostkova, P, Lorencatto, F, Richardson, M, Robson, J, Rockenschaub, P, Royston, C, Smith, CM, Sutton, E, Thomas, J, Tarrant, C, Traina, R, Richardson, E, West, J & Williams, H 2021, 'Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study', BMC Infectious Diseases, vol. 21, no. 1, 105. https://doi.org/10.1186/s12879-021-05811-7

Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study. / Smith, Catherine M.; Shallcross, Laura J.; Dutey-Magni, Peter et al.
In: BMC Infectious Diseases, Vol. 21, No. 1, 105, 22.01.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England

T2 - results from the Bug Watch community cohort study

AU - Smith, Catherine M.

AU - Shallcross, Laura J.

AU - Dutey-Magni, Peter

AU - Conolly, Anne

AU - Fuller, Christopher

AU - Hill, Suzanne

AU - Jhass, Arnoupe

AU - Marcheselli, Franziska

AU - Michie, Susan

AU - Mindell, Jennifer S.

AU - Ridd, Matthew J.

AU - Tsakos, Georgios

AU - Hayward, Andrew C.

AU - Fragaszy, Ellen B.

AU - Anderson, Niall

AU - Atkins, Lou

AU - Crayton, Elise

AU - Denaxas, Spiros

AU - Elsay, Nadia

AU - Forbes, Gillian

AU - Fragaszy, Ellen

AU - Freemantle, Nick

AU - Gill, Martin

AU - Horne, Rob

AU - Kostkova, Patty

AU - Lorencatto, Fabiana

AU - Richardson, Michelle

AU - Robson, John

AU - Rockenschaub, Patrick

AU - Royston, Claire

AU - Smith, Catherine M.

AU - Sutton, Elizabeth

AU - Thomas, James

AU - Tarrant, Carolyn

AU - Traina, Rosanna

AU - Richardson, Emma

AU - West, Jonathan

AU - Williams, Haydn

N1 - Funding Information: This work is supported by the Economic and Social Research Council, grant number ES/P008321/1, as part of the Preserving Antibiotics through Safe Stewardship (PASS) project. Professor Hayward is a National Institute for Health Research (NIHR) Senior Investigator. MJR is funded by an NIHR Post-Doctoral Research Fellowship (PDF-2014 − 07-013). LS is funded by a NIHR Clinician Scientist Award (CS-2016-16-007). AJ is funded as an NIHR In-Practice Fellow. © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

PY - 2021/1/22

Y1 - 2021/1/22

N2 - Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.

AB - Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.

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KW - Antimicrobial Stewardship

KW - Cohort Studies

KW - Delivery of Health Care

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KW - Female

KW - Humans

KW - Incidence

KW - Infections/drug therapy

KW - Male

KW - Middle Aged

KW - Referral and Consultation/statistics & numerical data

KW - Surveys and Questionnaires

KW - Syndrome

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DO - 10.1186/s12879-021-05811-7

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SN - 1471-2334

VL - 21

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 105

ER -

Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study

Abstract

Bibliographical note

Keywords

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How does organisational context impact on antibiotic stewardship in primary care?

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