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Abstract
Objective The aims of this study were to describe community antibiotic prescribing patterns in individuals hospitalised with COVID-19, and to determine the association between experiencing diarrhoea, stratified by preadmission exposure to antibiotics, and mortality risk in this cohort.
Design/methods Retrospective study of the index presentations of 1153 adult patients with COVID-19, admitted between 1 March 2020 and 29 June 2020 in a South London NHS Trust. Data on patients’ medical history (presence of diarrhoea, antibiotic use in the previous 14 days, comorbidities); demographics (age, ethnicity, and body mass index); and blood test results were extracted. Time to event modelling was used to determine the risk of mortality for patients with diarrhoea and/or exposure to antibiotics.
Results 19.2% of the cohort reported diarrhoea on presentation; these patients tended to be younger, and were less likely to have recent exposure to antibiotics (unadjusted OR 0.64, 95% CI 0.42 to 0.97). 19.1% of the cohort had a course of antibiotics in the 2 weeks preceding admission; this was associated with dementia (unadjusted OR 2.92, 95% CI 1.14 to 7.49). After adjusting for confounders, neither diarrhoea nor recent antibiotic exposure was associated with increased mortality risk. However, the absence of diarrhoea in the presence of recent antibiotic exposure was associated with a 30% increased risk of mortality.
Conclusion Community antibiotic use in patients with COVID-19, prior to hospitalisation, is relatively common, and absence of diarrhoea in antibiotic-exposed patients may be associated with increased risk of mortality. However, it is unclear whether this represents a causal physiological relationship or residual confounding.
- diarrhoea
- COVID-19
- antibiotic therapy
Data availability statement
Data are available upon reasonable request. Data cannot be shared publicly due to restrictions associated with access granted to routinely collected information in the absence of informed consent. Requests for access to the data extract used for this study should be directed to kch-tr.cogstackrequests@nhs.net.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available upon reasonable request. Data cannot be shared publicly due to restrictions associated with access granted to routinely collected information in the absence of informed consent. Requests for access to the data extract used for this study should be directed to kch-tr.cogstackrequests@nhs.net.
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Footnotes
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Contributors BAM, AJK and BHH conceived the study. MAA, JG, and JT oversaw and contributed to the data extraction process. BAM, SS, ST, SON, ZC, GK, and EB prepared the data for analysis. BAM carried out the analysis, with input from JG and BHH. The first draft of the manuscript was prepared by BAM, with input from SS, ST, MP, AJK and BHH. All authors contributed to revising the manuscript and agreed to the final submitted version.
Funding This study received no direct funding. The funders who support the individual authors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders who support the individual authors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests JT received research support and funding from Innovate UK, Bristol Myers Squibb, and iRhythm Technologies, and holds shares <£5000 in GlaxoSmithKline and Biogen.
Provenance and peer review Not commissioned; externally peer reviewed.
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