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.

中文翻译：

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COVID-19 疫苗接种对老年人门诊抗生素处方的影响：一项自我控制的风险区间研究


背景 2019 冠状病毒病 （COVID-19） 疫苗接种与实验室确诊的严重急性呼吸系统综合症冠状病毒 2 （SARS-CoV-2） 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 感染状态如何。方法 我们纳入了 2020 年 12 月至 2022 年 12 月期间接种第一剂、第二剂和/或第三剂 COVID-19 疫苗的 ≥ 65 岁成年人。我们使用了自我控制的风险区间设计，并纳入了在接种疫苗前 2-6 周 （疫苗接种前或对照间隔） 或疫苗接种后 （疫苗接种后或风险区间） 接受抗生素处方的病例。我们使用条件 logistic 回归来估计在疫苗接种后间隔与疫苗接种前间隔内被开具 （1） 任何抗生素，（2） 典型的“呼吸道”感染抗生素，或 （3） 典型的“尿路”感染抗生素（阴性对照）的几率。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 469 923 剂疫苗符合纳入标准。接种疫苗后接受任何抗生素或呼吸道抗生素处方的几率低于接种疫苗前的间隔时间（分别为 aOR，.973;95% CI，.968–.978;aOR，.961;95% CI，.953–.968）。疫苗接种与尿液抗生素处方之间没有关联 （aOR， .996;95% CI， .987–1.006）。SARS-CoV-2 检测阳性率高 （>10%） 与低 （<5%） 的时期表明抗生素处方减少幅度更大（分别为 aOR，.875;95% CI，.845–.905;aOR，.996;95% CI，.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，尤其是在 SARS-CoV-2 高循环期间。