Esan, Oluwaseun B., Perera, Rafael, McCarthy, Noel D., Violato, Mara and Fanshawe, Thomas R. (2020) Incidence, risk factors, and health service burden of sequelae of Campylobacter and Non-typhoidal Salmonella infections in England, 2000-2015 : a retrospective cohort study using linked electronic health records Sequelae of gastrointestinal infections. Journal of Infection . doi:10.1016/j.jinf.2020.05.027 (In Press)

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Abstract

Reactive arthritis, irritable bowel syndrome (IBS), Guillain-Barré syndrome, ulcerative colitis, and Crohn's disease may be sequelae of Campylobacter or non-typhoidal Salmonella (NTS) infections. Proton pump inhibitors (PPI) and antibiotics may increase the risk of gastrointestinal infections (GII); however, their impact on sequelae onset is unclear. We investigated the incidence of sequelae, their association with antibiotics and PPI prescription, and assessed the economic impact on the NHS.


Methods
Data from the Clinical Practice Research Datalink for patients consulting their GP for Campylobacter or NTS infection, during 2000-2015, were linked to hospital, mortality, and Index of Multiple Deprivation data. We estimated the incidence of sequelae and deaths in the 12 months following GII. We conducted logistic regression modelling for the adjusted association with prescriptions. We compared differences in resource use and costs pre- and post-infection amongst patients with and without sequelae.


Findings
Of 20,471 patients with GII (Campylobacter 17,838), less than 2% (347) developed sequelae, with IBS (268) most common. Among Campylobacter patients, those with prescriptions for PPI within 12 months before and cephalosporins within 7-days before/after infection had elevated risk of IBS (adjusted odds ratio [aOR] 2.1, 1.5-2.9) and (aOR 3.6, 1.1-11.7) respectively. Campylobacter sequelae lead to ∼ £1.3 million, (£750,000, £1.7 million) in additional annual NHS expenditure.


Interpretation
Sequelae of Campylobacter and NTS infections are rare but associated with increased NHS costs. Prior prescription of PPI may be a modifiable risk factor. Incidence of sequelae, healthcare resource use and costs are essential parameters for future burden of disease studies.

Item Type:	Journal Article
Subjects:	R Medicine > RB Pathology R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Diseases -- Complications , Gastrointestinal system -- Diseases , Proton pump inhibitors
Journal or Publication Title:	Journal of Infection
Publisher:	Elsevier
ISSN:	0163-4453
Official Date:	2020
Dates:	Date Event 2020 Published 20 May 2020 Available 13 May 2020 Accepted
Date of first compliant deposit:	12 June 2020
DOI:	10.1016/j.jinf.2020.05.027
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	** Article version: AM ** From Elsevier via Jisc Publications Router ** History: accepted 13-05-2020; issue date 21-05-2020. ** Licence for AM version of this article starting on 18-05-2020: http://creativecommons.org/licenses/by-nc-nd/4.0/
Access rights to Published version:	Open Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID HP-RU-2002-10038 [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272 UNSPECIFIED Public Health England http://dx.doi.org/10.13039/501100002141 UNSPECIFIED University of East Anglia http://dx.doi.org/10.13039/501100000736 UNSPECIFIED Nuffield College, University of Oxford http://dx.doi.org/10.13039/501100000666
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