PDF(Pubmed)
Abstract：
BACKGROUND: Inappropriate or overuse of antibiotic prescribing in primary care highlights an opportunity for antimicrobial stewardship (AMS) programs aimed at reducing unnecessary use of antimicrobials through education, policies and practice audits that optimize antibiotic prescribing. Evidence from the early part of the pandemic indicates a high rate of prescribing of antibiotics for patients with COVID-19. It is crucial to surveil antibiotic prescribing by primary care providers from the start of the pandemic and into its endemic stage to understand the effects of the pandemic and better target effective AMS programs.
METHODS: This was a matched pair population-based cohort study that used electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Participants included all patients that visited their primary care provider and met the inclusion criteria for COVID-19, respiratory tract infection (RTI), or non-respiratory or influenza-like-illness (negative). Four outcomes were evaluated (a) receipt of an antibiotic prescription; (b) receipt of a non-antibiotic prescription; (c) a subsequent primary care visit (for any reason); and (d) a subsequent primary care visit with a bacterial infection diagnosis. Conditional logistic regression was used to evaluate the association between COVID-19 and each of the four outcomes. Each model was adjusted for location (rural or urban), material and social deprivation, smoking status, alcohol use, obesity, pregnancy, HIV, cancer and number of chronic conditions.
RESULTS: The odds of a COVID-19 patient receiving an antibiotic within 30 days of their visit is much lower than for patients visiting for RTI or for a non-respiratory or influenza-like-illnesses (AOR = 0.08, 95% CI[0.07, 0.09] compared to RTI, and AOR = 0.43, 95% CI[0.38, 0.48] compared to negatives). It was found that a patient visit for COVID-19 was much less likely to have a subsequent visit for a bacterial infection at all time points.
CONCLUSIONS: Encouragingly, COVID-19 patients were much less likely to receive an antibiotic prescription than patients with an RTI. However, this highlights an opportunity to leverage the education and attitude change brought about by the public health messaging during the COVID-19 pandemic (that antibiotics cannot treat a viral infection), to reduce the prescribing of antibiotics for other viral RTIs and improve antibiotic stewardship.
METHODS: This was a matched pair population-based cohort study that used electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Participants included all patients that visited their primary care provider and met the inclusion criteria for COVID-19, respiratory tract infection (RTI), or non-respiratory or influenza-like-illness (negative). Four outcomes were evaluated (a) receipt of an antibiotic prescription; (b) receipt of a non-antibiotic prescription; (c) a subsequent primary care visit (for any reason); and (d) a subsequent primary care visit with a bacterial infection diagnosis. Conditional logistic regression was used to evaluate the association between COVID-19 and each of the four outcomes. Each model was adjusted for location (rural or urban), material and social deprivation, smoking status, alcohol use, obesity, pregnancy, HIV, cancer and number of chronic conditions.
RESULTS: The odds of a COVID-19 patient receiving an antibiotic within 30 days of their visit is much lower than for patients visiting for RTI or for a non-respiratory or influenza-like-illnesses (AOR = 0.08, 95% CI[0.07, 0.09] compared to RTI, and AOR = 0.43, 95% CI[0.38, 0.48] compared to negatives). It was found that a patient visit for COVID-19 was much less likely to have a subsequent visit for a bacterial infection at all time points.
CONCLUSIONS: Encouragingly, COVID-19 patients were much less likely to receive an antibiotic prescription than patients with an RTI. However, this highlights an opportunity to leverage the education and attitude change brought about by the public health messaging during the COVID-19 pandemic (that antibiotics cannot treat a viral infection), to reduce the prescribing of antibiotics for other viral RTIs and improve antibiotic stewardship.
摘要：
背景：初级保健中抗生素处方的不当或过度使用凸显了抗生素管理（AMS）计划的机会，旨在通过教育减少不必要的抗生素使用，优化抗生素处方的政策和实践审核。大流行早期的证据表明，对COVID-19患者开抗生素的比例很高。从大流行开始到流行阶段，初级保健提供者必须监视抗生素处方，以了解大流行的影响并更好地针对有效的AMS计划。
方法：这是一项配对的基于人群的队列研究，使用来自加拿大初级保健前哨监测网络（CCSSN）的电子病历（EMR）数据。参与者包括所有访问其初级保健提供者并符合COVID-19，呼吸道感染（RTI）纳入标准的患者，或非呼吸道或流感样疾病（阴性）。评估了四个结果：（a）接受抗生素处方；（b）接受非抗生素处方；（c）随后的初级保健就诊（出于任何原因）；（d）随后的初级保健就诊诊断为细菌感染。使用条件逻辑回归评估COVID-19与四个结果中每个结果之间的关联。每个模型都根据位置(农村或城市)进行了调整，物质和社会剥夺，吸烟状况,酒精使用,肥胖，怀孕,艾滋病毒,癌症和慢性疾病的数量。
结果：COVID-19患者在就诊后30天内接受抗生素的几率远低于接受RTI或非呼吸道或流感样疾病就诊的患者（与RTI相比，AOR=0.08,95%CI[0.07,0.09]，与阴性相比，AOR=0.43，95%CI[0.38，0.48])。研究发现，接受COVID-19治疗的患者在所有时间点随后接受细菌感染治疗的可能性要小得多。
结论：令人鼓舞的是，与患有RTI的患者相比，COVID-19患者接受抗生素处方的可能性要小得多。然而,这凸显了一个机会，可以利用COVID-19大流行期间公共卫生信息带来的教育和态度变化(抗生素不能治疗病毒感染)，减少其他病毒性RTI的抗生素处方并改善抗生素管理。
方法：这是一项配对的基于人群的队列研究，使用来自加拿大初级保健前哨监测网络（CCSSN）的电子病历（EMR）数据。参与者包括所有访问其初级保健提供者并符合COVID-19，呼吸道感染（RTI）纳入标准的患者，或非呼吸道或流感样疾病（阴性）。评估了四个结果：（a）接受抗生素处方；（b）接受非抗生素处方；（c）随后的初级保健就诊（出于任何原因）；（d）随后的初级保健就诊诊断为细菌感染。使用条件逻辑回归评估COVID-19与四个结果中每个结果之间的关联。每个模型都根据位置(农村或城市)进行了调整，物质和社会剥夺，吸烟状况,酒精使用,肥胖，怀孕,艾滋病毒,癌症和慢性疾病的数量。
结果：COVID-19患者在就诊后30天内接受抗生素的几率远低于接受RTI或非呼吸道或流感样疾病就诊的患者（与RTI相比，AOR=0.08,95%CI[0.07,0.09]，与阴性相比，AOR=0.43，95%CI[0.38，0.48])。研究发现，接受COVID-19治疗的患者在所有时间点随后接受细菌感染治疗的可能性要小得多。
结论：令人鼓舞的是，与患有RTI的患者相比，COVID-19患者接受抗生素处方的可能性要小得多。然而,这凸显了一个机会，可以利用COVID-19大流行期间公共卫生信息带来的教育和态度变化(抗生素不能治疗病毒感染)，减少其他病毒性RTI的抗生素处方并改善抗生素管理。
