Antibiotic Overuse for COVID-19: Are We Adding Insult to Injury?

Abdela, Seid Getahun; Liesenborghs, Laurens; Tadese, Fentaw; Abegaz, Seid Hassen; Bayuh, Fentaw Bialfew; Asmamaw, Etsegenet Arega; Mebratie, Tamiru Asefa; Mamo, Abreham Eshetu; Mebrate, Maraki Assefa; Embiale, Wendemaegn; Hunegnaw, Samuel; Hundie, Dereje Bedanie; Hurissa, Zewdu; Agero, Gebi; Kaso, Abdene Weya; Henten, Saskia van; Griensven, Johan van

doi:10.4269/ajtmh.21-0603

Cited by 11 publications

(7 citation statements)

References 4 publications

(4 reference statements)

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“…This is the first study from Serbia looking at antibiotic use in COVID-19 patients, revealing a very high prescribing rate. Despite the fact that only a small number of patients have coinfections (4.0% in our case), our results support numerous studies indicating disproportionately high rates of antibiotic prescribing without a clear indication [ 9 , 10 , 11 , 12 ]. Antibiotic use in Serbia is plagued by the poor health education of the general public which leads to frequent self-medication and overall misuse [ 8 , 13 , 14 , 15 ].…”

Section: Discussionsupporting

confidence: 83%

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

et al. 2022

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Antimicrobial resistance (AMR) is a global concern, and antibiotic use has risen throughout the COVID-19 pandemic. Up to 75% of COVID-19 patients are treated with antibiotics despite little evidence for their use. A retrospective study from 6 March 2020 (the start of the pandemic in Serbia) to 31 December 2021 was conducted at the Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia. In total, 523 patients with a microbiological diagnosis of COVID-19 were included. Patient data were analysed, including antibiotic use before and after admission. Pre-admission use of antibiotics for COVID-19 treatment was documented in more than half of patients (58.1%), of which a third (34.1%) used more than one antibiotic. Macrolides, cephalosporins, and fluoroquinolones were mainly used, most frequently among patients aged between 31–45 years (75.2%). Prior antibiotic use was associated with a longer duration of illness at admission (8.8 vs. 5.7, p < 0.001), oxygen therapy upon admission (27.6% vs. 16.0%, p = 0.002), and a lower vaccination rate (60.7% vs. 50.7%, p = 0.04). When hospitalised, 72.1% of patients received antibiotics, primarily cephalosporins (71.9%). Significant efforts are needed to reduce antibiotic use in the community and improve prescribing rates by healthcare professionals.

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Section: Discussionsupporting

confidence: 83%

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

et al. 2022

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“…During the initial outbreak of the COVID-19 pandemic, a large number of individuals and patients were treated with antimicrobials, despite the outbreak being caused by a virus [4]. And although less than 12% of patients presenting with COVID-19 at the time required antibiotics, most of these patients received them nonetheless [4,5]. The spread of false information via the media contributed immensely to aggravating the scenario, raising the consumption of non-recommended antibiotics during the pandemic, resulting in close to 67% of individuals self-medicating with antimicrobials prior to their hospital presentation with viral infections [6].…”

Section: Discussionmentioning

confidence: 99%

Antibiogram at a Rural Hospital Against the Background of COVID-19: A Five-Year Retrospective Review

Okobi¹,

Evbayekha²,

Shittu³

et al. 2022

Cureus

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Background and objectiveThe role of the antibiogram in reducing hospital length of stay (LOS), mortality rate, health care costs, and, by extension, patients' social, physical, and emotional wellness has a significant impact on the medical community. Hospitals in large cities serve a dynamic population of diverse ethnic groups. Many scholarly works and publications have shown that the antimicrobial pattern in rural settings has significant variability annually. Over the last two years, the spread of coronavirus disease 2019 (COVID-19) has brought about many unknowns in the sphere of healthcare. The pattern of pathology accompanying COVID-19 has affected hospital policies and direct patient management, leading to a paradigm shift in approaches, policies, and resource utilization. The years 2019 to 2021 were marked by many admissions due to COVID-19, and the effects of COVID-19 are still being studied. In light of this, this study examined the changes in sensitivity patterns, new trends, and nature of bacteria isolates, antimicrobial rates, and susceptibility based on a rural hospital's annual antibiogram pertaining to its central departments: the intensive care unit (ICU), patient care unit (PCU), the outpatient unit, and emergency department (ED). MethodsThis five-year retrospective antibiogram review compared antibiogram patterns two years before the first case of COVID-19 was reported in the hospital and those two years after the initial outbreak. ResultsThe organism comparative susceptibility tests for Escherichia coli (E. coli) were not significant except for increased susceptibility toward nitrofurantoin (p=0.003); Klebsiella pneumoniae (K. pneumoniae) was also not significant except for the increased susceptibility to ciprofloxacin (p=0.003). Pseudomonas aeruginosa (P. aeruginosa) had no changes in susceptibility patterns, while Proteus mirabilis (P. mirabilis) had increased susceptibility to imipenem (p=0.05), aztreonam (p=0.00), and meropenem (p=0.004), with reduced susceptibility to gentamicin (97.47% vs. 88.24%, p=0.006). There was a whopping decrease in the sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) to clindamycin (75.93% vs. 50.7%, p=0.000), linezolid (99.54% vs. 88.73, p=0.004), trimethoprim/sulfamethoxazole (92.59% vs. 74.65%, p=0.001), and vancomycin (99.54% vs. 88.73%, p=0.004). Staphylococcus aureus (S. aureus) had no significant variation except an increase in susceptibility to nitrofurantoin (p=0.023), and perhaps ironically, Streptococcus pneumoniae (S. pneumoniae) had no significant changes in susceptibility pattern.

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“…Finally, antibiotic consumption is high among COVID-19 patients, especially in hospitalized settings where the main rate of usage reaches up to 74% [ 70 ]. In addition to possibly increasing antimicrobial resistance [ 71 ], the inappropriate use of antibiotics, especially those with well-known hepatotoxicity (such as azithromycin), may lead to additional liver damage [ 72 ].…”

Section: Drug-induced Liver Injurymentioning

confidence: 99%

COVID-19: Has the Liver Been Spared?

Brandi

Spinelli

Granito

et al. 2023

IJMS

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The liver is a secondary and often collateral target of COVID-19 disease but can lead to important consequences. COVID-19 might directly cause a high number of complications in patients with pre-existing chronic liver disease, increasing their risk of hepatic decompensation. Moreover, it also determines indirect consequences in the management of patients with liver disease, especially in those suffering from decompensated cirrhosis and HCC, as well as in the execution of their follow-up and the availability of all therapeutic possibilities. Liver imaging in COVID-19 patients proved to be highly nonspecific, but it can still be useful for identifying the complications that derive from the infection. Moreover, the recent implementation of telemedicine constitutes a possible solution to both the physical distancing and the re-organizational difficulties arising from the pandemic. The present review aims to encompass the currently hypothesized pathophysiological mechanisms of liver injury in patients with COVID-19 mediated by both the direct invasion of the virus and its indirect effects and analyze the consequence of the pandemic in patients with chronic liver disease and liver tumors, with particular regard to the management strategies that have been implemented to face this worldwide emergency and that can be further improved.

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Antibiotic Overuse for COVID-19: Are We Adding Insult to Injury?

Cited by 11 publications

References 4 publications

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

Antibiogram at a Rural Hospital Against the Background of COVID-19: A Five-Year Retrospective Review

COVID-19: Has the Liver Been Spared?

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