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Use of antibiotics in hospitalized patients with COVID-19: evolving concepts in a highly dynamic antimicrobial
Matteo Bassetti1,2, Giorgia Brucci1,2, Antonio Vena1,2
1Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Introduction:
Excessive use of antibiotics has been frequently reported in hospitalized patients with COVID-19 worldwide, compared to the actual number of bacterial co-infections or super-infections.
Areas Covered:
In this perspective, we discuss the current literature on the use of antibiotics and antimicrobial stewardship interventions in hospitalized patients with COVID-19. A search was conducted in PubMed up to March 2023.
Expert Opinion:
The COVID-19 pandemic has witnessed an excessive use of antibiotics in hospitals worldwide, especially before the advent of COVID-19 vaccination, although according to the most recent data there is still an important disproportion between the prevalence of antibiotic use and that of proven bacterial coinfection or superinfections. An important reduction in the prevalence of antibiotic use in COVID-19 patients reported in the literature, from 70-100% to 50-60%, has been observed after successful vaccination campaigns, likely related to the reduced median disease severity of hospitalized COVID-19 patients and some successful interventions of antimicrobial and diagnostic stewardship. However, the disproportion between antibiotic use and the prevalence of bacterial infections (4-6%) is still uncomfortable from an antimicrobial stewardship perspective and requires further attention.
Insights
Hospitalized COVID-19 patients were overprescribed antibiotics, despite low rates of bacterial infections. Antimicrobial stewardship interventions are crucial to address this ongoing disproportion and optimize antibiotic use.
Area of Science:
- Infectious Diseases
- Public Health
- Pharmacology
Background:
- Antibiotic overuse was prevalent in hospitalized COVID-19 patients globally, particularly before widespread vaccination.
- A significant disparity exists between the high rates of antibiotic prescription and the low incidence of confirmed bacterial co-infections or super-infections.
Purpose of the Study:
- To review the existing literature on antibiotic utilization and antimicrobial stewardship strategies in COVID-19 patients.
- To highlight the persistent imbalance between antibiotic use and bacterial infection rates.
Main Methods:
- A literature search was performed using PubMed up to March 2023.
- The review focused on studies examining antibiotic use and stewardship interventions in hospitalized COVID-19 patients.
Main Results:
- Antibiotic use in COVID-19 patients decreased from 70-100% to 50-60% post-vaccination, linked to reduced disease severity and stewardship efforts.
- Despite this reduction, bacterial infections remain low at 4-6%, indicating continued inappropriate antibiotic prescribing.
Conclusions:
- The persistent disproportion between antibiotic use and documented bacterial infections in COVID-19 patients warrants further attention.
- Enhanced antimicrobial stewardship and diagnostic interventions are essential to curb unnecessary antibiotic prescriptions.
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