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Antibiotic Use and Associated Risk Factors for Antibiotic Prescribing in COVID-19 Hospitalized Patients
Alysa J Martin1, Stephanie Shulder1, David Dobrzynski2
1Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
Insights
High antibiotic prescribing occurred in COVID-19 patients, with 83% receiving antibiotics despite low infection rates. Many patients received multiple antibiotic courses, highlighting the need for better antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Hospital Medicine
- Pharmacology
Background:
- Antibiotic prescribing in COVID-19 patients is frequently high.
- Data on drivers of antibiotic prescribing during the pandemic are limited.
Purpose of the Study:
- To determine antibiotic use rates in hospitalized COVID-19 patients.
- To identify risk factors for antibiotic prescribing and for receiving multiple antibiotic courses.
Main Methods:
- Retrospective, multi-center, observational study.
- Included patients admitted from March 1, 2020, to May 31, 2020, treated for COVID-19.
- Assessed antibiotic use, risk factors, and microbiologically confirmed infections.
Main Results:
- 83% of patients received at least one antibiotic course; 30% received more than one.
- Low rates of microbiologically confirmed bacterial co-infection (12%).
- Risk factors for antibiotic use included longer hospital stay, ICU admission, and mechanical ventilation.
Conclusions:
- High rates of antibiotic prescribing were observed in COVID-19 patients, often without confirmed bacterial co-infection.
- Multiple antibiotic courses were common during hospitalization.
- Emphasizes the critical need for robust antibiotic stewardship programs for COVID-19 patients.
Background:
Literature suggests that antibiotic prescribing in COVID-19 patients is high. Currently, there are insufficient data on what drives antibiotic prescribing practices throughout the COVID-19 pandemic.
Objective:
This study sought to determine antibiotic use rates and identify risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than 1 course of antibiotics.
Methods:
This was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020, to May 31, 2020, and treated for COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than 1 antibiotic course, and rate of microbiologically confirmed infections.
Results:
A total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least 1 course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than 1 course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than 1 course of antibiotics included increased hospital length of stay (median 12 days), intensive care unit admission, and the necessity for mechanical ventilation.
Conclusion And Relevance:
There were high rates of antibiotic prescribing with low rates of microbiologically confirmed bacterial co-infection. Many patients received more than 1 course of antibiotics during hospitalization. This study highlights the importance and demand for appropriate antibiotic stewardship practices in COVID-19 patients.
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