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MacFadden, Derek R; Maxwell, Colleen; Bowdish, Dawn; Bronskill, Susan; Brooks, James; Brown, Kevin; Burrows, Lori L; Clarke, Anna; Langford, Bradley; Leung, Elizabeth; Leung, Valerie; Manuel, Doug; McGeer, Allison; Mishra, Sharmistha; Morris, Andrew M; Nott, Caroline; Raybardhan, Sumit; Sapin, Mia; Schwartz, Kevin L; So, Miranda; Soucy, Jean-Paul R; Daneman, Nick
Clinical infectious diseases, 08/2023, Volume: 77, Issue: 3Journal Article
Abstract Background Antibiotics are frequently prescribed unnecessarily in outpatients with coronavirus disease 2019 (COVID-19). We sought to evaluate factors associated with antibiotic prescribing in outpatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods We performed a population-wide cohort study of outpatients aged ≥66 years with polymerase chain reaction–confirmed SARS-CoV-2 from 1 January 2020 to 31 December 2021 in Ontario, Canada. We determined rates of antibiotic prescribing within 1 week before (prediagnosis) and 1 week after (postdiagnosis) reporting of the positive SARS-CoV-2 result, compared to a self-controlled period (baseline). We evaluated predictors of prescribing, including a primary-series COVID-19 vaccination, in univariate and multivariable analyses. Results We identified 13 529 eligible nursing home residents and 50 885 eligible community-dwelling adults with SARS-CoV-2 infection. Of the nursing home and community residents, 3020 (22%) and 6372 (13%), respectively, received at least 1 antibiotic prescription within 1 week of a SARS-CoV-2 positive result. Antibiotic prescribing in nursing home and community residents occurred, respectively, at 15.0 and 10.5 prescriptions per 1000 person-days prediagnosis and 20.9 and 9.8 per 1000 person-days postdiagnosis, higher than the baseline rates of 4.3 and 2.5 prescriptions per 1000 person-days. COVID-19 vaccination was associated with reduced prescribing in nursing home and community residents, with adjusted postdiagnosis incidence rate ratios (95% confidence interval) of 0.7 (0.4–1) and 0.3 (0.3–0.4), respectively. Conclusions Antibiotic prescribing was high and with little or no decline following SARS-CoV-2 diagnosis but was reduced in COVID-19–vaccinated individuals, highlighting the importance of vaccination and antibiotic stewardship in older adults with COVID-19. Outpatient antibiotic use around the time of SARS-CoV-2 diagnosis is common. A completed primary COVID-19 (2-dose) vaccination series is associated with significantly reduced antibiotic use around the time of SARS-CoV-2 diagnosis. Graphical Abstract Graphical Abstract
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