Peri-Covid-19 Antibiotic Use and Antimicrobial Resistance in Older Adults.

NEJM evidence Pub Date : 2025-10-01 Epub Date: 2025-09-23 DOI:10.1056/EVIDoa2400108
Derek R MacFadden, Colleen Maxwell, Dawn Bowdish, Susan Bronskill, James Brooks, Kevin Brown, Lori L Burrows, Anna E Clarke, Bradley J Langford, Elizabeth Leung, Valerie Leung, Doug Manuel, Allison McGeer, Sharmistha Mishra, Andrew M Morris, Caroline Nott, Sumit Raybardhan, Mia E Sapin, Kevin L Schwartz, Miranda So, Jean-Paul R Soucy, Nick Daneman
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引用次数: 0

Abstract

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).

老年人covid -19围产期抗生素使用和抗微生物药物耐药性
背景:2019冠状病毒病(Covid-19)大流行期间抗生素的使用在门诊很常见,但没有得到指南的支持。我们试图评估这种抗生素的使用对下游抗生素耐药性的作用。方法:从2020年1月1日至2021年6月30日,我们对加拿大安大略省所有66岁及以上未住院的成年人进行了一项全人群队列研究,首次发现了严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)。我们评估了门诊患者在covid -19周围的抗生素暴露(在SARS-CoV-2报告之前或之后的7天内)与6个月内从临床培养中下游分离出抗生素耐药菌之间的关系。我们计算了covid -19围产期处方与抗生素耐药生物检测之间的校正比值比,以及下游抗生素耐药生物的校正归因分数。结果:在纳入的53,533名符合条件的个体中,8228人(15%)使用了covid -19周围的抗生素,1477人(3%)发现了下游抗生素耐药菌。在covid -19周围使用抗生素的任何抗生素耐药菌存在的校正比值比为1.24(95%可信区间[CI], 1.09至1.41),而革兰氏阴性抗生素耐药菌存在的校正比值比为1.27 (95% CI, 1.11至1.46),革兰氏阳性抗生素耐药菌存在的校正比值比为1.02 (95% CI, 0.70至1.48)。在SARS-CoV-2诊断后7天内接受抗生素治疗的所有个体中,与covid -19周围抗生素使用相关的下游抗菌素耐药性归因比例为17% (95% CI, 7 - 26%)。在所有诊断为SARS-CoV-2的个体中,与covid -19周围抗生素使用相关的下游抗菌素耐药性的人群归因比例为4% (95% CI, 2 - 7%)。结论:covid -19围产期抗生素使用与下游抗菌素耐药性有关,特别是革兰氏阴性抗生素耐药生物的存在。(由加拿大卫生研究所业务补助金[赠款号179461]和其他资助)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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