NEJM evidence · 2025
Peri-Covid-19 Antibiotic Use and Antimicrobial Resistance in Older Adults.
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MacFadden Derek R, Maxwell Colleen, Bowdish Dawn, Bronskill Susan, Brooks James, Brown Kevin, Burrows Lori L, Clarke Anna E, Langford Bradley J, Leung Elizabeth, Leung Valerie, Manuel Doug, McGeer Allison, Mishra Sharmistha, Morris Andrew M, Nott Caroline, Raybardhan Sumit, Sapin Mia E, Schwartz Kevin L, So Miranda, Soucy Jean-Paul R, Daneman Nick
Аннотация
BACKGROUND: Antibiotic use during the coronavirus disease 2019 (Covid-19) pandemic was common in the outpatient setting, but was not supported by guidelines. We sought to evaluate the role of this antibiotic use on downstream antibiotic resistance.
METHODS: We performed a population-wide cohort study of all nonhospitalized adults 66 years of age or older in Ontario, Canada, from January 1, 2020, to June 30, 2021, with a first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the relationship between outpatient peri-Covid-19 antibiotic exposure (within a period of 7 days before or after index SARS-CoV-2 reporting) and downstream isolation of an antibiotic-resistant organism from clinical culture within 6 months. We calculated adjusted odds ratios of the association between peri-Covid-19 prescribing and antibiotic-resistant organism detection, as well as the adjusted attributable fractions of downstream antibiotic-resistant organisms.
RESULTS: Of the 53,533 eligible individuals included, 8228 (15%) were prescribed a peri-Covid-19 antibiotic, and 1477 (3%) had a downstream antibiotic-resistant organism identified. The adjusted odds ratio for the presence of any antibiotic-resistant organism with peri-Covid-19 antibiotic use was 1.24 (95% confidence interval [CI], 1.09 to 1.41), while the adjusted odds ratio for the presence of gram-negative antibiotic-resistant organisms was 1.27 (95% CI, 1.11 to 1.46) and for gram-positive antibiotic-resistant organisms it was 1.02 (95% CI, 0.70 to 1.48). Among all individuals who received an antibiotic within 7 days of SARS-CoV-2 diagnosis, the attributable fraction of downstream antimicrobial resistance related to peri-Covid-19 antibiotic use was 17% (95% CI, 7 to 26%). Among all individuals with a SARS-CoV-2 diagnosis, the population-attributable fraction of downstream antimicrobial resistance related to peri-Covid-19 antibiotic use was 4% (95% CI, 2 to 7%).
CONCLUSIONS: Peri-Covid-19 antibiotic use was associated with downstream antimicrobial resistance, and particularly the presence of gram-negative antibiotic-resistant organisms. (Funded by the Canadian Institutes of Health Research Operating Grant [grant number 179461] and others).
METHODS: We performed a population-wide cohort study of all nonhospitalized adults 66 years of age or older in Ontario, Canada, from January 1, 2020, to June 30, 2021, with a first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the relationship between outpatient peri-Covid-19 antibiotic exposure (within a period of 7 days before or after index SARS-CoV-2 reporting) and downstream isolation of an antibiotic-resistant organism from clinical culture within 6 months. We calculated adjusted odds ratios of the association between peri-Covid-19 prescribing and antibiotic-resistant organism detection, as well as the adjusted attributable fractions of downstream antibiotic-resistant organisms.
RESULTS: Of the 53,533 eligible individuals included, 8228 (15%) were prescribed a peri-Covid-19 antibiotic, and 1477 (3%) had a downstream antibiotic-resistant organism identified. The adjusted odds ratio for the presence of any antibiotic-resistant organism with peri-Covid-19 antibiotic use was 1.24 (95% confidence interval [CI], 1.09 to 1.41), while the adjusted odds ratio for the presence of gram-negative antibiotic-resistant organisms was 1.27 (95% CI, 1.11 to 1.46) and for gram-positive antibiotic-resistant organisms it was 1.02 (95% CI, 0.70 to 1.48). Among all individuals who received an antibiotic within 7 days of SARS-CoV-2 diagnosis, the attributable fraction of downstream antimicrobial resistance related to peri-Covid-19 antibiotic use was 17% (95% CI, 7 to 26%). Among all individuals with a SARS-CoV-2 diagnosis, the population-attributable fraction of downstream antimicrobial resistance related to peri-Covid-19 antibiotic use was 4% (95% CI, 2 to 7%).
CONCLUSIONS: Peri-Covid-19 antibiotic use was associated with downstream antimicrobial resistance, and particularly the presence of gram-negative antibiotic-resistant organisms. (Funded by the Canadian Institutes of Health Research Operating Grant [grant number 179461] and others).