Abstract：
BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination has been associated with reduced outpatient antibiotic prescribing among older adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the impact of COVID-19 vaccination on outpatient antibiotic prescribing in the broader population of older adults, regardless of SARS-CoV-2 infection status.
METHODS: We included adults aged ≥65 years who received their first, second, and/or third COVID-19 vaccine dose from December 2020 to December 2022. We used a self-controlled risk-interval design and included cases who received an antibiotic prescription 2-6 weeks before vaccination (pre-vaccination or control interval) or after vaccination (post-vaccination or risk interval). We used conditional logistic regression to estimate the odds of being prescribed (1) any antibiotic, (2) a typical \"respiratory\" infection antibiotic, or (3) a typical \"urinary tract\" infection antibiotic (negative control) in the post-vaccination interval versus the pre-vaccination interval. We accounted for temporal changes in antibiotic prescribing using background monthly antibiotic prescribing counts.
RESULTS: 469 923 vaccine doses met inclusion criteria. The odds of receiving any antibiotic or a respiratory antibiotic prescription were lower in the post-vaccination versus pre-vaccination interval (aOR, .973; 95% CI, .968-.978; aOR, .961; 95% CI, .953-.968, respectively). There was no association between vaccination and urinary antibiotic prescriptions (aOR, .996; 95% CI, .987-1.006). Periods with high (>10%) versus low (<5%) SARS-CoV-2 test positivity demonstrated greater reductions in antibiotic prescribing (aOR, .875; 95% CI, .845-.905; aOR, .996; 95% CI, .989-1.003, respectively).
CONCLUSIONS: COVID-19 vaccination was associated with reduced outpatient antibiotic prescribing in older adults, especially during periods of high SARS-CoV-2 circulation.
METHODS: We included adults aged ≥65 years who received their first, second, and/or third COVID-19 vaccine dose from December 2020 to December 2022. We used a self-controlled risk-interval design and included cases who received an antibiotic prescription 2-6 weeks before vaccination (pre-vaccination or control interval) or after vaccination (post-vaccination or risk interval). We used conditional logistic regression to estimate the odds of being prescribed (1) any antibiotic, (2) a typical \"respiratory\" infection antibiotic, or (3) a typical \"urinary tract\" infection antibiotic (negative control) in the post-vaccination interval versus the pre-vaccination interval. We accounted for temporal changes in antibiotic prescribing using background monthly antibiotic prescribing counts.
RESULTS: 469 923 vaccine doses met inclusion criteria. The odds of receiving any antibiotic or a respiratory antibiotic prescription were lower in the post-vaccination versus pre-vaccination interval (aOR, .973; 95% CI, .968-.978; aOR, .961; 95% CI, .953-.968, respectively). There was no association between vaccination and urinary antibiotic prescriptions (aOR, .996; 95% CI, .987-1.006). Periods with high (>10%) versus low (<5%) SARS-CoV-2 test positivity demonstrated greater reductions in antibiotic prescribing (aOR, .875; 95% CI, .845-.905; aOR, .996; 95% CI, .989-1.003, respectively).
CONCLUSIONS: COVID-19 vaccination was associated with reduced outpatient antibiotic prescribing in older adults, especially during periods of high SARS-CoV-2 circulation.
摘要：
背景：2019年冠状病毒病（COVID-19）疫苗接种与实验室确诊的严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）的老年人门诊抗生素处方减少有关。我们评估了COVID-19疫苗接种对更广泛的老年人群门诊抗生素处方的影响，无论SARS-CoV-2感染状况如何。
方法：我们纳入了年龄≥65岁的成年人，第二,和/或2020年12月至2022年12月的第三次COVID-19疫苗剂量。我们使用自我控制的风险区间设计，并包括在疫苗接种前2-6周（疫苗接种前或控制间隔）或疫苗接种后（疫苗接种后或风险间隔）接受抗生素处方的病例。我们使用条件逻辑回归来估计被处方的几率(1)任何抗生素，（2）典型的“呼吸道”感染抗生素，或（3）疫苗接种后间隔与疫苗接种前间隔的典型“尿路感染”抗生素（阴性对照）。我们使用背景每月抗生素处方计数来解释抗生素处方的时间变化。
结果：469923剂疫苗符合纳入标准。与接种前间隔相比，接种后接种任何抗生素或呼吸道抗生素处方的几率较低(aOR，.973；95%CI，.968-.978；OR，.961；95%CI，分别为.953-.968）。疫苗接种和尿液抗生素处方之间没有关联(aOR，.996；95%CI，.987-1.006）。高(>10%)与低(<5%)SARS-CoV-2试验阳性的时期显示抗生素处方的更大减少(aOR,.875；95%CI，.845-.905；OR，.996；95%CI，分别为.989-1.003）。
结论：COVID-19疫苗接种与老年人门诊抗生素处方减少有关，特别是在SARS-CoV-2高循环期间。
方法：我们纳入了年龄≥65岁的成年人，第二,和/或2020年12月至2022年12月的第三次COVID-19疫苗剂量。我们使用自我控制的风险区间设计，并包括在疫苗接种前2-6周（疫苗接种前或控制间隔）或疫苗接种后（疫苗接种后或风险间隔）接受抗生素处方的病例。我们使用条件逻辑回归来估计被处方的几率(1)任何抗生素，（2）典型的“呼吸道”感染抗生素，或（3）疫苗接种后间隔与疫苗接种前间隔的典型“尿路感染”抗生素（阴性对照）。我们使用背景每月抗生素处方计数来解释抗生素处方的时间变化。
结果：469923剂疫苗符合纳入标准。与接种前间隔相比，接种后接种任何抗生素或呼吸道抗生素处方的几率较低(aOR，.973；95%CI，.968-.978；OR，.961；95%CI，分别为.953-.968）。疫苗接种和尿液抗生素处方之间没有关联(aOR，.996；95%CI，.987-1.006）。高(>10%)与低(<5%)SARS-CoV-2试验阳性的时期显示抗生素处方的更大减少(aOR,.875；95%CI，.845-.905；OR，.996；95%CI，分别为.989-1.003）。
结论：COVID-19疫苗接种与老年人门诊抗生素处方减少有关，特别是在SARS-CoV-2高循环期间。
