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Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections

Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections

How to cite: Ali Fahmi, Victoria Palin, Xiaomin Zhong, Ya-Ting Yang, Simon Watts, Darren M Ashcroft, Ben Goldacre, Brian Mackenna, Louis Fisher, Jon Massey, Amir Mehrkar, Seb Bacon, OpenSAFELY collaborative, Kieran Hand, Tjeerd Pieter van Staa medRxiv 2023.07.16.23292723; doi: https://doi.org/10.1101/2023.07.16.23292723

Abstract

Background

Antimicrobial resistance (AMR) is a multifaceted global challenge, partly driven by inappropriate antibiotic prescribing. The COVID-19 pandemic impacted antibiotic prescribing for common bacterial infections. This highlights the need to examine risk of hospital admissions related to common infections, excluding COVID-19 infections during the pandemic.

Methods

With the approval of NHS England, we accessed electronic health records from The Phoenix Partnership (TPP) through OpenSAFELY platform. We included patients with primary care diagnosis of common infections, including lower respiratory tract infection (LRTI), upper respiratory tract infections (URTI), and lower urinary tract infection (UTI), from January 2019 to August 2022. We excluded patients with a COVID-19 record 90 days before to 30 days after the infection diagnosis. Using Cox proportional-hazard regression models, we predicted risk of infection-related hospital admission in 30 days follow-up period after the diagnosis.

Results

We found 12,745,165 infection diagnoses from January 2019 to August 2022. Of them, 80,395 (2.05%) cases were admitted to hospital in the follow-up period. Counts of hospital admission for infections dropped during COVID-19, e.g., LRTI from 3,950 in December 2019 to 520 in April 2020. Comparing those prescribed an antibiotic to those without, reduction in risk of hospital admission were largest with LRTI (adjusted odds ratio (OR) of 0.35; 95% CI, 0.35-0.36) and UTI (adjusted OR 0.45; 95% CI, 0.44-0.46), compared to URTI (adjusted OR 1.04; 95% CI, 1.03-1.06).

Conclusion

Large effectiveness of antibiotics in preventing complications related to LRTI and UTI can support better targeting of antibiotics to patients with higher complication risks.

Key messages

  • The main drivers of infection-related hospital admission are age, Charlson comorbidity index, and history of prior antibiotics.
  • Antibiotics are more effective in preventing hospital admission related to infections such as lower respiratory tract infection and urinary tract infection, rather than upper respiratory tract infection.
  • Common antibiotic types are associated with more reduction in the risk of infection-related hospital admission.