Antibiotic use in patients with COVID-19: a ‘snapshot’ Infectious Diseases International Research Initiative (ID-IRI) survey

Abstract

Background Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection. Objectives To investigate antibiotic prescribing practices in patients with COVID-19. Methods We performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis. Results The survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of β-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days. Conclusions The study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.

Clinical Characteristics of 47 Death Cases With COVID-19: A Retrospective Study at a Tertiary Center in Lahore

“…However, the rational use of antibiotics still remains justified. ARDS was the major complication leading to death in our series followed by cardiac complications, multi-organ failure, and septic shock, which is consistent with previous literature [14,16,18,20,23].…”

Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

“…First, as outlined by a recent survey, broad-spectrum antibiotic use in patients with COVID-19 is extremely frequent, with piperacillin/tazobactam as the most frequently prescribed antibiotic. 13 Interestingly, the use of piperacillin/tazobactam was associated with increased risk of subsequent superinfections in our series. The use of antibiotics in patients with severe SARS-CoV-2 pneumonia, except for documented bacterial coinfection or superinfection, has no demonstrated efficacy and increases the risk of MDRO selection.…”

Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?

“…• About 70% of hospitalised COVID-19 patients receive antibiotics [33,34] • COVID-19 patients often receive empiric broad-spectrum antibiotic therapy [34][35][36] • 16% of hospitalised COVID-19 patients develop a secondary bacterial infection [34], which will necessitate antibiotic therapy…”