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Antibiotic use in patients with Coronavirus disease 2019 (COVID-19): outcomes and associated factors
Sandrine Milas1, Arthur Poncelet1, Fabrizio Buttafuoco1
1Department of Internal Medicine and Infectious Diseases, Charleroi University Hospital, Lodelinsart, Belgium.
Insights
Antibiotic use in COVID-19 patients was high, particularly in the ICU and among older adults, but did not improve outcomes. Antimicrobial stewardship programs are crucial for managing antibiotic use during pandemics.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Antibiotic use surged during the COVID-19 pandemic, raising concerns about overuse.
- Understanding factors influencing antibiotic prescription and their impact on patient outcomes is critical.
Purpose of the Study:
- To characterize factors associated with antibiotic use in hospitalized COVID-19 patients.
- To analyze outcomes and infection rates in this patient cohort.
- To evaluate the effectiveness of antibiotic treatment in COVID-19 patients.
Main Methods:
- Retrospective review of RT-PCR-confirmed COVID-19 patients hospitalized between March and May 2020.
- Analysis of factors associated with antibiotic treatment, patient outcomes, and bacterial infections.
- Multivariate analysis to identify predictors of antibiotic use.
Main Results:
- 61% of COVID-19 patients received antibiotics; ICU admission, age >65, nursing home origin, diabetes, bilateral lung consolidation, and elevated C-reactive protein were associated with antibiotic use.
- Confirmed infections were present in 17.1% of patients, predominantly urinary tract infections; respiratory coinfections were rare (1.2%).
- Antibiotic treatment did not significantly reduce length of stay or mortality.
Conclusions:
- Antibiotic overuse was observed in COVID-19 patients, despite a low incidence of bacterial coinfections.
- Antimicrobial stewardship programs are essential components of pandemic response strategies.
- Further research is needed to optimize antibiotic use in viral respiratory infections.
Objectives:
To characterise the factors, outcomes and infections associated with antibiotic use in COVID-19 patients.
Methods:
Records of patients with RT-PCR-confirmed COVID-19, hospitalized at the CHU Charleroi (Belgium) between 11 March and 3 May 3 2020, were retrospectively reviewed. Factors associated with antibiotic treatment, outcomes and bacterial infections were analysed.
Results:
Among the 164 hospitalized COVID-19 patients (median age 60.5 years [IQR] 46-79), twenty-five (15.2%) were admitted to the ICU. Twenty-six (15.9%) died in the hospital. One hundred (61%) received antibiotic treatment. Combination therapies with macrolides were more common in the early part of the study period (26/67, 38.8%). Twenty-eight patients (17.1%) had a confirmed infection, mostly of the urinary tract (18/28, 64.3%). Only 2 (1.2%) had a documented respiratory coinfection. Six of the 7 ICU infections (85.7%) were superinfections. Gram-negative bacteria were most frequently isolated. In multivariate analysis, six factors were associated with antibiotic use: being hospitalized in the ICU (OR: 4.59; 95% CI 1.07-19.71), age > 65 years (OR: 4.16; 95% CI 1.72-10.05), arrival from a nursing home (OR: 4.59; 95% CI 1.11-19.71), diabetes (OR: 4.35; 95% CI 1.26-14.93), bilateral consolidation on chest CT (OR: 9.92; 95% CI 2.40-41.06) and a C-reactive protein level > 60 mg/L (OR:2.46; 95% CI 1.13-5.37). Antibiotic treatment did not reduce the length of stay or the mortality rate.
Conclusion:
Antibiotics have been overused during the COVID-19 pandemic, despite a low rate of coinfections . Integrating the antimicrobial stewardship (AMS) programme into the COVID-19 response is essential.
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