Exploring Prior Antibiotic Exposure Characteristics for COVID-19 Hospital Admission Patients: OpenSAFELY

Author:

Yang Ya-Ting1ORCID,Wong David12ORCID,Zhong Xiaomin1ORCID,Fahmi Ali1ORCID,Ashcroft Darren M.34ORCID,Hand Kieran5ORCID,Massey Jon6ORCID,Mackenna Brian6,Mehrkar Amir6ORCID,Bacon Sebastian6ORCID,Goldacre Ben6,Palin Victoria17ORCID,van Staa Tjeerd1ORCID

Affiliation:

1. Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK

2. Leeds Institute of Health Sciences, The University of Leeds, Leeds LS2 9JT, UK

3. Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK

4. National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK

5. National Health Service (NHS) England, Wellington House, Waterloo Road, London SE1 8UG, UK

6. Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK

7. Division of Developmental Biology and Medicine, Maternal and Fetal Research Centre, St Marys Hospital, The University of Manchester, Manchester M13 9WL, UK

Abstract

Previous studies have demonstrated the association between antibiotic use and severe COVID-19 outcomes. This study aimed to explore detailed antibiotic exposure characteristics among COVID-19 patients. Using the OpenSAFELY platform, which integrates extensive health data and covers 40% of the population in England, the study analysed 3.16 million COVID-19 patients with at least two prior antibiotic prescriptions. These patients were compared to up to six matched controls without hospitalisation records. A machine learning model categorised patients into ten groups based on their antibiotic exposure history over the three years before their COVID-19 diagnosis. The study found that for COVID-19 patients, the total number of prior antibiotic prescriptions, diversity of antibiotic types, broad-spectrum antibiotic prescriptions, time between first and last antibiotics, and recent antibiotic use were associated with an increased risk of severe COVID-19 outcomes. Patients in the highest decile of antibiotic exposure had an adjusted odds ratio of 4.8 for severe outcomes compared to those in the lowest decile. These findings suggest a potential link between extensive antibiotic use and the risk of severe COVID-19. This highlights the need for more judicious antibiotic prescribing in primary care, primarily for patients with higher risks of infection-related complications, which may better offset the potential adverse effects of repeated antibiotic use.

Funder

Health Data Research UK

National Institute for Health research

NHS England

The Wellcome Trust

MRC

MRC via the National Core Study programme, Longitudinal Health and Wellbeing strand

Data and Connectivity strand

NIHR and MRC via the CONVALESCENCE programme

NHS England via the Primary Care Medicines Analytics Unit

Publisher

MDPI AG

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