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

Abstract

Background: Broad-spectrum empirical antimicrobials are frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims: We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design: The study was a national, multicenter, retrospective, and single-day point prevalence study. Methods: This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results: A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age ± standard deviation of the patients was 65.0 ± 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (37.2%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital ( p < 0.001), requiring any supplemental oxygen ( p = 0.005), presence of moderate/diffuse lung involvement ( p < 0.001), C-reactive protein > 10 ULT coefficient ( p < 0.001), lymphocyte count < 800 ( p = 0.007), and clinical diagnosis and/or confirmation by culture ( p < 0.001) were found to be independent factors associated with increased antibiotic use. Conclusion: The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.

Physicians’ irrational attitudes on the antibiotic prescribing for the treatment of COVID-19 in Turkey: A multicenter survey

“…In a large-scale study conducted mainly with hospitalized Covid-19 patients in Turkey, the rate of antibiotic use was 46%, and antibiotic use was associated with a 9.29-fold increase in mortality [ 5 ]. Another a multi-center study from Turkey was reported that two-thirds of the patients hospitalized with a diagnosis of COVID-19 received antibiotics and the inappropriate antibiotic prescribing rate was 71.2% [ 13 ]. However, only hospitalized patients were included in this study.…”

“…However, only 46 physicians from Turkey participated in this study [ 9 ]. In a few studies involving hospitalized patients in our nation, respiratory quinolones were the most frequently prescribed antibiotics [ 5 – 10 , 13 ]. Similarly in our study the most prescribed antibiotics were respiratory quinolones.…”

Prevalence of Antibiotic Use in Hospitalized COVID-19 Patients: An Observational Study in Secondary Healthcare Hospitals in Kosovo

“…12 A Turkish study shown that 74.5% of patients were treated with antibiotics in which 37.2% of them were treated with a combination of antibiotics, although 71.2% of them had neither clinical diagnosis nor microbiological data to justify their use. 7 A study conducted in Indonesia shown that even though bacterial cultures were positive in 18.3% of patients, 83.4% of them were treated with antibiotics in which azithromycin were prescribed in 44.3% of patients. 13 Daria and Islam showed that in South Asia, antibiotics were widely used with 72% of patients receiving different antibiotics, although only 1-16% of cases had data on the presence of bacterial infections.…”

“…5 A retrospective study reported that cephalosporins, macrolides, quinolones, and ampicillin/clavulanic acid were the most prescribed antibiotics among hospitalized COVID-19 patients. [6][7][8][9][10] A study showed the pattern of antibiotic use in patients with COVID-19 and bacterial infections, highlighting the urgent need for further research to assess the effect of COVID-19 on antimicrobial resistance at both the patient and population levels. 10 Thus, we conducted a study aimed to describe the prevalence of antibiotic use in hospitalized COVID-19 patients in hospitalized patients in secondary healthcare hospitals in Kosovo.…”

Antibiotic resistance of microorganisms isolated from patients with communityacquired pneumonia associated with the new coronavirus infection (COVID-19) in a polyclinic hospital in the city of Tomsk

“…По результатам нашего исследования у 8% пациентов с внебольничной пневмонией, ассоциированной с COVID-19, наблюдалось выделение бактериальных патогенов, что согласуется с зарубежными данными. В многоцентровом ретроспективном исследовании в Турции было установлено, что 28,2% пациентов с диагнозом COVID-19 имели клинический диагноз бактериальной инфекции, при этом только в 7,1% случаев диагноз был подтвержден бактериологически [4]. В систематическом обзоре, опубликованном в 2021 году и посвященном изучению частоты использования антибиотиков у пациентов с COVID-19, сообщается, что средняя частота назначения антибиотиков составляла 74,0%.…”