To Prescribe, or Not to Prescribe, That Is the Question

Rhee, Chin Kook

doi:10.3346/jkms.2022.37.e240

Cited by 1 publication

(1 citation statement)

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“… 26 Considering the low rate of bacterial co-infection and potential harm of antibacterial use such as inducing antimicrobial resistance and antibacterial drug-related toxicities, empiric use of antibacterials should be restricted in patients with COVID-19 unless the microbiological evidence or clinical suspicion of bacterial infection is evident. 27 On the other hand, despite the low rate, since the bacterial co-infection is an important risk factor for COVID-19 mortality, microbiological tests such as sputum culture and blood culture should be performed for all hospitalized COVID-19 patients. 15 28 In particular, an early diagnosis strategy for bacterial co-infection for the appropriate use of antibacterials should be implemented.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19

et al. 2023

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Background The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. Methods In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. Results Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. Conclusion In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.

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