TY - JOUR
T1 - Diarrhoea and preadmission antibiotic exposure in COVID-19
T2 - a retrospective cohort study of 1153 hospitalised patients
AU - Mateen, Bilal Akhter
AU - Samanta, Sandip
AU - Tullie, Sebastian
AU - O'Neill, Sarah
AU - Cargill, Zillah
AU - Kelly, Gillian
AU - Brennan, Ewen
AU - Patel, Mehul
AU - Al-Agil, Mohammad
AU - Galloway, James
AU - Teo, James
AU - Shawcross, Debbie L.
AU - Kent, Alexandra J.
AU - Hayee, Bu'Hussain
N1 - Funding Information:
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.
Funding Information:
Acknowledgements We are extremely grateful to all the clinicians and other staff who have looked after our patients. We thank the patient experts of the KERRI committee, Professor Clive Kay, Professor Alastair Baker, Professor Irene Higginson and Professor Jules Wendon for their support. We acknowledge the excellent help of Chris Fry, Dominic Thurgood and Isuf Ali in the KCHFT Business Intelligence Unit. Moreover, we thank MAA and the Cogstack team for their support with data extraction. Finally, BAM is a fellow of The Alan Turing Institute, and acknowledges indirect support by EPSRC grant (EP/N510129/), as well as being an employee of the Wellcome Trust which supports his academic appointment at UCL IHI. 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.
Publisher Copyright:
©
PY - 2021/9/6
Y1 - 2021/9/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85114699720&partnerID=8YFLogxK
U2 - 10.1136/bmjgast-2020-000593
DO - 10.1136/bmjgast-2020-000593
M3 - Article
C2 - 34489301
SN - 2054-4774
VL - 8
JO - BMJ open gastroenterology
JF - BMJ open gastroenterology
IS - 1
M1 - e000593
ER -