6723e559839044cde3de052348f067b0 pmc_34827302.pdf 23c657b61394a767d555f3599d7ae10166c32cc2 pmc_34827302.pdf c5c4b56a7b30c994dd4c546b92cee13970a5dfd3c423fbdc4d4b454c46543e7d pmc_34827302.pdf Title: Correlation between Previous Antibiotic Exposure and COVID-19 Severity. A Population-Based Cohort Study Subject: We examined the correlation between previous antibiotic exposure and COVID-19 severity using a population-based observational matched cohort study with patient level data obtained for more than 5.8 million people registered in SIDIAP in Catalonia, Spain. We included all patients newly diagnosed with COVID-19 from March to June 2020 and identified all their antibiotic prescriptions in the previous two years. We used a composite severity endpoint, including pneumonia, hospital admission and death due to COVID-19. We examined the influence of high antibiotic exposure (>4 regimens), exposure to highest priority critically important antimicrobials (HPCIA) and recent exposure. Potential confounders were adjusted by logistic regression. A total of 280,679 patients were diagnosed with COVID-19, 146,656 of whom were exposed to at least one antibiotic course (52.3%) during the preceding two years. A total of 25,222 presented severe COVID-19 infection (9%), and the risk of severity was highest among those exposed to antibiotics (OR 1.12; 95% CI: 1.04–1.21). Among all individuals exposed to antibiotics, high, recent and exposure to HPCIAs were correlated with increased COVID severity (OR 1.19; 95% CI: 1.14–1.26; 1.41; 95% CI: 1.36–1.46; and 1.35; 95% CI: 1.30–1.40, respectively). Our findings confirm a significant correlation between previous antibiotic exposure and increased severity of COVID-19 disease. Keywords: drug resistance; microbial; primary health care; COVID-19; anti-bacterial agents Author: Carl Llor, Dan Ouchi, Maria Giner-Soriano, Ana García-Sangenís, Lars Bjerrum and Rosa Morros Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Nov 9 01:27:44 2021 CET ModDate: Tue Nov 9 01:45:06 2021 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 663156 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- KORLVE+VnURWPalladioL Type 1 Custom yes yes no 10 0 BNPZEF+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 ZZMLEM+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 WADQHX+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 WLENKM+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 37 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 59 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 63 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 67 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 82 0 PDTLUH+CMSY10 Type 1 Builtin yes yes no 86 0 SQDJII+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 99 0 HKMVKE+PalatinoLinotype-Italic TrueType WinAnsi yes yes yes 107 0 NDSKQS+PalatinoLinotype-Bold TrueType WinAnsi yes yes yes 111 0 GYEPWG+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 115 0 NBMAQS+Calibri TrueType WinAnsi yes yes yes 119 0 HKMVKE+PalatinoLinotype-Italic TrueType WinAnsi yes yes yes 134 0 NDSKQS+PalatinoLinotype-Bold TrueType WinAnsi yes yes yes 138 0 GYEPWG+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 142 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-11-23 05:26:23 CET RepresentationInformation: pmc_34827302.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:06:19 CEST Size: 663156 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 293 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Children: Item: Title: Study Population Destination: subsection.2.1 Item: Title: The Correlation between Previous Use of Antibiotics and COVID-19 Severity Destination: subsection.2.2 Item: Title: Discussion Destination: section.3 Item: Title: Methods Destination: section.4 Children: Item: Title: Study Design, Setting and Participants Destination: subsection.4.1 Item: Title: Data Collection Destination: subsection.4.2 Item: Title: Drug Exposure Destination: subsection.4.3 Item: Title: Variables and Outcomes Destination: subsection.4.4 Item: Title: Statistical Analysis Destination: subsection.4.5 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Correlation between Previous Antibiotic Exposure and COVID-19 Severity. A Population-Based Cohort Study Author: Carl Llor, Dan Ouchi, Maria Giner-Soriano, Ana García-Sangenís, Lars Bjerrum and Rosa Morros Subject: We examined the correlation between previous antibiotic exposure and COVID-19 severity using a population-based observational matched cohort study with patient level data obtained for more than 5.8 million people registered in SIDIAP in Catalonia, Spain. We included all patients newly diagnosed with COVID-19 from March to June 2020 and identified all their antibiotic prescriptions in the previous two years. We used a composite severity endpoint, including pneumonia, hospital admission and death due to COVID-19. We examined the influence of high antibiotic exposure (>4 regimens), exposure to highest priority critically important antimicrobials (HPCIA) and recent exposure. Potential confounders were adjusted by logistic regression. A total of 280,679 patients were diagnosed with COVID-19, 146,656 of whom were exposed to at least one antibiotic course (52.3%) during the preceding two years. A total of 25,222 presented severe COVID-19 infection (9%), and the risk of severity was highest among those exposed to antibiotics (OR 1.12; 95% CI: 1.04 1.21). Among all individuals exposed to antibiotics, high, recent and exposure to HPCIAs were correlated with increased COVID severity (OR 1.19; 95% CI: 1.14 1.26; 1.41; 95% CI: 1.36 1.46; and 1.35; 95% CI: 1.30 1.40, respectively). Our findings confirm a significant correlation between previous antibiotic exposure and increased severity of COVID-19 disease. 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