Empirical Antibiotic Prescribing in Adult COVID-19 Inpatients over Two Years in Mexico

Abstract

Background and Objectives: Empirical antibiotic prescribing in patients with coronavirus disease 2019 (COVID-19) has been common even though bacterial coinfections are infrequent. The overuse of antibacterial agents may accelerate the antibiotic resistance crisis. We aimed to evaluate factors predicting empirical antibiotic prescribing to adult COVID-19 inpatients over 2 years (March 2020–February 2021) in Mexico. Materials and Methods: A cross-sectional analysis of a nationwide cohort study was conducted. Hospitalized adults due to laboratory-confirmed COVID-19 were included (n = 214,171). Odds ratios (OR) and 95% confidence intervals (CI), computed by using logistic regression models, were used to evaluate factors predicting empirical antibiotic prescribing. Results: The overall frequency of antibiotic usage was 25.3%. In multiple analysis, the highest risk of antibiotic prescription was documented among patients with pneumonia at hospital admission (OR = 2.20, 95% CI 2.16–2.25). Male patients, those with chronic comorbidities (namely obesity and chronic kidney disease) and longer interval days from symptoms onset to healthcare seeking, were also more likely to receive these drugs. We also documented that, per each elapsed week during the study period, the odds of receiving antibiotic therapy decreased by about 2% (OR = 0.98, 95% CI 0.97–0.99). Conclusion: Our study identified COVID-19 populations at increased risk of receiving empirical antibiotic therapy during the first two years of the pandemic.

The Impact of Early Antibiotic Use on Clinical Outcomes of Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis

“…Consistent with other research, most reported epidemiological investigations from China and Spain also showed similarly low bacterial co-infection rates [17][18][19]. However, it's worth noting that the proportion of hospitalized COVID-19 patients who received antibiotics far exceeds the reported prevalence of microbiologically proven co-infection [9,20].…”

Prevalence of Self-Medication and Associated Factors among Healthcare Students during the COVID-19 Pandemic: A Cross-Sectional Study at the University of Zambia

“…Despite the recommended use of azithromycin to treat bacterial infections associated with COVID-19, its inappropriate use may promote the development of AMR (Bogdanić et al, 2022;Butler et al, 2021). The overuse of antibiotics in our study and similar studies is a public health concern, especially with the growing rates of antimicrobial-resistant pathogens (Daria & Islam, 2022;Mudenda et al, 2022c;Murillo-Zamora et al, 2022;Murray et al, 2022;Schnall et al, 2019). These findings indicate the need to develop and implement antimicrobial stewardship (AMS) programmes in universities to promote the rational use of antibiotics (Kusuma et al, 2022;Liew et al, 2020;Majumder et al, 2020;Ogunnigbo et al, 2022).…”

Bacterial Co-Infection in Patients with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescription

“…However, stewardship decisions were made at the clinician's discretion. The medical reasoning supporting this decision for COVID-19 patients is to treat possible community-acquired bacterial pneumonia and the difficulty in distinguishing between bacteria-and virus-related symptoms, given that both cause unspecific symptoms such as coughing and a fever [21]. Besides the risk related to the secondary effects of different medications, another increasingly worrying problem with the broad use of empiric antimicrobial therapy is the rise of antimicrobial resistance.…”