The Association between Previous Antibiotic Consumption and SARS-CoV-2 Infection: A Population-Based Case-Control Study
Matan Dugot, Eugene Merzon, Shai Ashkenazi, Shlomo Vinker, Ilan Green, Avivit Golan-Cohen, Ariel Israel
Antibiotics, doi:10.3390/antibiotics12030587
Background: The susceptibility to SARS-CoV-2 infection is complex and not yet fully elucidated, being related to many variables; these include human microbiome and immune status, which are both affected for a long period by antibiotic use. We therefore aimed to examine the association of previous antibiotic consumption and SARS-CoV-2 infection in a large-scale population-based study with control of known confounders. Methods: A matched case-control study was performed utilizing the electronic medical records of a large Health Maintenance Organization. Cases were subjects with confirmed SARS-CoV-2 infection (n = 31,260), matched individually (1:4 ratio) to controls without a positive SARS-CoV-2 test (n = 125,039). The possible association between previous antibiotic use and SARS-CoV-2 infection was determined by comparing antibiotic consumption in the previous 6 and 12 months between the cases and controls. For each antibiotic consumed we calculated the odds ratio (OR) for documented SARS-CoV-2 infection, 95% confidence interval (CI), and p-value using univariate and multivariate analyses. Results: The association between previous antibiotic consumption and SARS-CoV-2 infection was complex and bi-directional. In the multivariate analysis, phenoxymethylpenicillin was associated with increased rate of SARS-CoV-2 infection (OR 1.110, 95% CI: 1.036-1.191) while decreased rates were associated with previous consumption of trimethoprim-sulfonamides (OR 0.783, 95% CI: 0.632-0.971) and azithromycin (OR 0.882, 95% CI: 0.829-0.938). Fluroquinolones were associated with decreased rates (OR 0.923, 95% CI: 0.861-0.989) only in the univariate analysis. Previous consumption of other antibiotics had no significant association with SARS-CoV-2 infection. Conclusions: Previous consumption of certain antibiotic agents has an independent significant association with increased or decreased rates of SARS-CoV-2 infection. Plausible mechanisms, that should be further elucidated, are mainly antibiotic effects on the human microbiome and immune modulation.
Conflicts of Interest: The authors declare no conflict of interest.
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doi:10.1053/j.gastro.2020.06.048{ 'indexed': {'date-parts': [[2023, 3, 16]], 'date-time': '2023-03-16T04:45:25Z', 'timestamp': 1678941925135},
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'abstract': '<jats:p>Background: The susceptibility to SARS-CoV-2 infection is complex and not yet fully '
'elucidated, being related to many variables; these include human microbiome and immune '
'status, which are both affected for a long period by antibiotic use. We therefore aimed to '
'examine the association of previous antibiotic consumption and SARS-CoV-2 infection in a '
'large-scale population-based study with control of known confounders. Methods: A matched '
'case–control study was performed utilizing the electronic medical records of a large Health '
'Maintenance Organization. Cases were subjects with confirmed SARS-CoV-2 infection (n = '
'31,260), matched individually (1:4 ratio) to controls without a positive SARS-CoV-2 test (n = '
'125,039). The possible association between previous antibiotic use and SARS-CoV-2 infection '
'was determined by comparing antibiotic consumption in the previous 6 and 12 months between '
'the cases and controls. For each antibiotic consumed we calculated the odds ratio (OR) for '
'documented SARS-CoV-2 infection, 95% confidence interval (CI), and p-value using univariate '
'and multivariate analyses. Results: The association between previous antibiotic consumption '
'and SARS-CoV-2 infection was complex and bi-directional. In the multivariate analysis, '
'phenoxymethylpenicillin was associated with increased rate of SARS-CoV-2 infection (OR 1.110, '
'95% CI: 1.036–1.191) while decreased rates were associated with previous consumption of '
'trimethoprim-sulfonamides (OR 0.783, 95% CI: 0.632–0.971) and azithromycin (OR 0.882, 95% CI: '
'0.829–0.938). Fluroquinolones were associated with decreased rates (OR 0.923, 95% CI: '
'0.861–0.989) only in the univariate analysis. Previous consumption of other antibiotics had '
'no significant association with SARS-CoV-2 infection. Conclusions: Previous consumption of '
'certain antibiotic agents has an independent significant association with increased or '
'decreased rates of SARS-CoV-2 infection. Plausible mechanisms, that should be further '
'elucidated, are mainly antibiotic effects on the human microbiome and immune '
'modulation.</jats:p>',
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