Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers

Abstract

This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th–May 4th, 2020), excluding short-term admissions (< 24 h). Antibiotic prescriptions were analyzed and quantified, using Defined Daily Doses (DDD) per admission and per 100 bed days. Possible drivers of antibiotic prescribing were identified by means of mixed effects logistic modelling analysis with backwards selection. Of all included admissions ( n = 429), 39% ( n = 171) were prescribed antibiotics for (presumed) respiratory tract superinfection (3.6 DDD/admission; 31.5 DDD/100 bed days). Consumption of beta-lactamase inhibitor–penicillin combinations was the highest (2.55 DDD/admission; 23.3 DDD/100 bed days). Four drivers were identified: fever on admission (OR 2.97; 95% CI 1.42–6.22), lower SpO 2 /FiO 2 ratio on admission (OR 0.96; 95% CI 0.92–0.99), underlying pulmonary disease (OR 3.04; 95% CI 1.12–8.27) and longer hospital stay (OR 1.09; 95% CI 1.03–1.16). We present detailed quantitative antibiotic data for presumed respiratory tract superinfections in hospitalized COVID-19 patients. In addition to knowledge on antibiotic consumption, we hope antimicrobial stewardship programs will be able to use the drivers identified in this study to optimize their interventions in COVID-19 wards. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-021-02790-0.

Antibiotic Prescriptions Targeting Bacterial Respiratory Infections in Admitted Patients with COVID-19: A Prospective Observational Study

“…Research suggests that the number of DDD may also be associated with a decreased antibiotic susceptibility [24]. In our study, the reported antibiotic consumption for COVID-19 confirmed admissions (0.87 DDD/admission and 8.92 DDD/100 hospital bed days) was lower than in a previously performed retrospective study by this research group (3.6 DDD/admission and 31.5 DDD/100 hospital bed days) [35]. Importantly, antibiotic consumption in ICU patients was taken into account in the retrospective study whereas this was not the case in the current prospective study.…”

“…A metaanalysis by Langford et al (2021) reported an antibiotic prescription rate of 71% [7]. A comparable retrospective study observed a prescription rate of 59% for respiratory antibiotics in ward patients [35]. The reasons for lower antibiotic prescription rate observed in our study are multiple: the prospective design of the study, the successful functioning of the AST with close follow-up of antibiotic prescriptions and an inclusion period that succeeded the first COVID-19 wave.…”

Antibiotic use and Influencing Factors Among Hospitalized Patients with COVID-19: A Multicenter Point-Prevalence Study from Turkey

“…In a study from Belgium, fever and a low SpO 2 /FiO 2 (single peripheral blood oxygen saturation/fraction of inspired oxygen) ratio at presentation, underlying lung disease, and longer hospital stays were reported as the factors associated with antibiotics prescription for possible respiratory superinfection in patients with COVID-19. 21 Another study reported that the most important reason motivating clinicians to initiate antibiotic therapy was the clinical presentation, followed by laboratory markers of inflammation and radiological findings. 3 Based on past experiences, clinicians often make unnecessary decisions to prescribe antibiotics for patients with severe disease.…”

Is There a Need to Widely Prescribe Antibiotics in Patients with COVID-19?

“…В 96% случаев назначения АБ госпитализированным пациентам с COVID-19 препарат назначался при поступлении или в течение первых 48 ч после госпитализации, однако есть указания на более поздний период назначения АБ -в среднем семь дней [14,17,30,35]. Обзор назначения антибиотиков в 15 больницах Шотландии показывает, что в 62,4% случаев лечение антибиотиками начинали в день поступления пациента [36].…”

“…Интересно, что наличие сопутствующих заболеваний не показало своей значимости в отношении назначения АБ [9]. Ещё в одном исследовании были выявлены следующие факторы, ассоциированные с назначением АБ: ли-хорадка при поступлении (ОШ 2,97; 95% ДИ 1, 22), более низкое отношение SpO₂/FiO₂ при поступлении (ОШ 0,96; 95% ДИ 0,92-0,99), ранее существовавшее заболевание лёгких (ОШ 3,04; 95% ДИ 1,12-8,27) и повышение уровня нейтрофилов [35].…”