A retrospective antibiotic prescribing assessment and examination of potential antibiotic stewardship targets in patients with COVID-19

Abstract

Objectives Despite low rates of bacterial coinfection in patients admitted with COVID-19, antimicrobials are frequently prescribed. Our primary objective was to evaluate antimicrobial prescribing over time in patients admitted with COVID-19. The secondary objectives were to evaluate the role of ID providers in antimicrobial utilization, describe the rate of confirmed bacterial infection and determine factors associated with empirical antimicrobial prescribing in COVID-19. Materials and methods Retrospective review was performed for adult patients admitted to a tertiary care centre with COVID-19 between 1 March 2020 and 30 November 2020. Patient demographics, disease severity, risk factors for severe disease, clinical outcomes, antimicrobial prescribing and respiratory microbiological testing were collected and analysed. Prescribing trends were evaluated by month, and factors contributing to prescribing were established using univariate and multivariable analysis. Results Antibiotics were prescribed during admission in 37.9% of the study cohort, with 85.1% of patients who received antibiotics having therapy initiated within 48 h of admission. Antibiotic prescribing incidence increased with disease. Over the study period, antimicrobial prescribing rates decreased by 8.7% per month. Multivariable analysis found ICU admission, obtainment of procalcitonin values, intubation, heart failure, haemodialysis and nursing home residence were associated with empirical antimicrobial prescribing. Conclusions Unnecessary antimicrobial prescribing in patients with viral syndromes like COVID-19 continues to represent an area of concern. Antimicrobial stewardship efforts during COVID-19 should consider patient-specific factors associated with antibiotic prescribing. Recognition of such factors, in combination with application of well-established antimicrobial stewardship tactics, may serve to impact antimicrobial prescribing trends, even as patient volumes rise.

Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis

“…Similar to existing publications, we noted an increased use of antibiotics during the pandemic. [16][17][18][19] Compared to existing publications, our antibiotic use metrics were normalized with the use of patient day data, and we adjusted for prior antibiotic prescribing trends and seasonality with the use of an interrupted time-series analysis. We also analyzed antibiotic use between different pandemic waves to examine the evolution of antibiotic prescribing as new publications and guidelines were developed throughout the first 3 waves of the pandemic.…”

“…[12][13][14][15] Although some published data are available from the inpatient setting (generally demonstrating increased rates of antimicrobial prescribing during the first wave of the COVID-19 pandemic), most of these studies have only described early pandemic prescribing, and antibiotic use metrics were not always standardized to patient volumes or compared to baseline prescribing patterns. [16][17][18][19] Published data on the impact of the pandemic on ASPs, and how changes in ASPs may have affected antimicrobial consumption trends, are also limited. One study, which demonstrated a decrease in antimicrobial prescribing in COVID-19 units compared to historical controls, hypothesized that the ASP was responsible for the decreased rates of antimicrobial use.…”

COVID-19 Associated Cardiovascular Disease—Risks, Prevention and Management: Heart at Risk Due to COVID-19

“…The use of systemic corticosteroids in patients with confirmed COVID-19 pneumonia who require oxygen therapy due to hypoxia decreases mortality [ 76 , 77 , 78 , 79 , 80 , 81 ]. Antibiotics are not routinely started because bacterial coinfection with COVID-19 is rare; however, a broad-spectrum antibiotic regimen is used if a superimposed infection is suspected [ 82 , 83 , 84 ].…”