Sijbom Martijn, Büchner Frederike L, Saadah Nicholas H, de Boer Mark Gj, Numans Mattijs E
Department of Public Health and Primary Care, location Health Campus The Hague, Leiden University Medical Center, Leiden, The Netherlands
Department of Public Health and Primary Care, location Health Campus The Hague, Leiden University Medical Center, Leiden, The Netherlands.
BJGP Open. 2022 Dec 20;6(4). doi: 10.3399/BJGPO.2022.0049. Print 2022 Dec.
Antibiotics are frequently prescribed during viral respiratory infection episodes in primary care. There is limited information about antibiotic prescription during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in primary care and its association with risk factors for an adverse course.
To compare the proportion of antibiotic prescriptions between patients with COVID-19 and influenza or influenza-like symptoms, and to assess the association between antibiotic prescriptions and risk factors for an adverse course of COVID-19.
DESIGN & SETTING: An observational cohort study using pseudonymised and coded routine healthcare data extracted from 85 primary care practices in the Netherlands.
Adult patients with influenza and influenza-like symptoms were included from the 2017 influenza season to the 2020 season. Adult patients with suspected or confirmed COVID-19 were included from the first (15 February 2020-1 August 2020) and second (1 August 2020-1 January 2021) SARS-CoV-2 waves. Proportions of antibiotic prescriptions were calculated for influenza and COVID-19 patients. Odds ratios (ORs) were used to compare the associations of antibiotic prescriptions in COVID-19 patients with risk factors, hospital admission, intensive care unit (ICU) admission, and mortality.
The proportion of antibiotic prescriptions during the first SARS-CoV-2 wave was lower than during the 2020 influenza season (9.6% versus 20.7%), difference 11.1% (95% confidence interval [CI] = 8.7 to 13.5). During the second SARS-CoV-2 wave, antibiotic prescriptions were associated with being aged ≥70 years (OR 2.05; 95% CI = 1.43 to 2.93), the number of comorbidities (OR 1.46; 95% CI = 1.18 to 1.82), and admission to hospital (OR 3.19; 95% CI = 2.02 to 5.03) or ICU (OR 4.64; 95% CI = 2.02 to 10.62).
Antibiotic prescription was less common during the SARS-CoV-2 pandemic than during influenza seasons, and was associated with an adverse course and its risk factors. The findings suggest a relatively targeted prescription policy of antibiotics in primary care during COVID-19.
在基层医疗中，病毒感染性呼吸道疾病发作时经常会开具抗生素处方。关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行期间基层医疗中的抗生素处方及其与不良病程风险因素的关联，相关信息有限。
比较新型冠状病毒肺炎（COVID-19）患者与流感或流感样症状患者的抗生素处方比例，并评估抗生素处方与COVID-19不良病程风险因素之间的关联。
一项观察性队列研究，使用从荷兰85家基层医疗机构提取的化名编码常规医疗数据。
纳入2017年流感季至2020年流感季有流感和流感样症状的成年患者。纳入2020年2月15日至8月1日第一波和2020年8月1日至2021年1月1日第二波SARS-CoV-2疫情中疑似或确诊COVID-19的成年患者。计算流感患者和COVID-19患者的抗生素处方比例。使用比值比（OR）比较COVID-19患者抗生素处方与风险因素、住院、重症监护病房（ICU）入院及死亡之间的关联。
第一波SARS-CoV-2疫情期间抗生素处方比例低于2020年流感季（9.6%对20.7%），差值为11.1%（95%置信区间[CI]=8.7至13.5）。在第二波SARS-CoV-2疫情期间，抗生素处方与年龄≥70岁（OR 2.05；95%CI=1.43至2.93）、合并症数量（OR 1.46；95%CI=1.18至1.82）以及住院（OR 3.19；95%CI=2.02至5.03）或ICU入院（OR 4.64；95%CI=2.02至10.62）相关。
SARS-CoV-2大流行期间抗生素处方比流感季少见，且与不良病程及其风险因素相关。研究结果提示COVID-19期间基层医疗中抗生素的处方政策相对具有针对性。
