Antibiotic use patterns and factors associated with leukocyte decrease in COVID-19 patients with suspected secondary...

Area of Science:

• Infectious Diseases
• Pharmacology
• Public Health

Background:

• Antibiotic overuse in COVID-19 patients is a significant concern, contributing to antimicrobial resistance.
• Secondary bacterial infections in COVID-19 require careful antibiotic management to avoid resistance and improve outcomes.
• Understanding current antibiotic prescribing patterns is crucial for developing targeted interventions.

Purpose of the Study:

• To analyze antibiotic prescribing patterns in hospitalized COVID-19 patients with suspected secondary infections.
• To evaluate the association between antibiotic use and clinical outcomes, focusing on leukocyte count.
• To identify frequently prescribed antibiotics and associated pathogens in this patient cohort.

Main Methods:

• Retrospective analysis of 376 hospitalized COVID-19 patients (≥17 years) with elevated leukocyte counts.
• Utilized Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) and drug utilization (DU) 90% methods for pattern assessment.
• Collected demographic, clinical, culture data, and antibiotic therapy information.

Main Results:

• Most patients received multiple antibiotics (>2), with patterns linked to age, bacterial pathogens, hospital stay duration, and tuberculosis.
• Common pathogens included *Staphylococcus aureus*, *S. haemolyticus*, *Klebsiella pneumoniae*, *Acinetobacter baumannii*, and *Escherichia coli*.
• Azithromycin, levofloxacin, and ceftriaxone were most frequently prescribed; no significant association found between antibiotic quantity and leukocyte normalization.

Conclusions:

• Broad-spectrum antibiotics, particularly from the WHO AWaRe 'Watch' category, were prevalent.
• While antibiotic selection considered pathogen type and comorbidities, standardized guidelines are essential for optimizing use, especially where pathogen testing is limited.
• Addressing inappropriate antibiotic use in COVID-19 is critical to combatting antimicrobial resistance.