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

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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.
Funding Information
  • Health Data Research UK (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • National Institute for Health Research (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • NHS England (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • The Wellcome Trust (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • MRC (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • MRC via the National Core Study programme, Longitudinal Health and Wellbeing strand (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • Data and Connectivity strand (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • NIHR and MRC via the CONVALESCENCE programme (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)
  • NHS England via the Primary Care Medicines Analytics Unit (222097/Z/20/Z, MR/V015737/1, MC_PC_20030, MC_PC_20059, MC_PC_20029, MC_PC_20058, COV-LT-0009, MC_PC_20051)

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