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

Johan Van Laethem, Stephanie Wuyts, Sven Van Laere, Silke Dirkx, Lucie Seyler, Rembert Mertens, Bart Ilsen, Patrick Lacor, Denis Pierard, Sabine D Allard, Johan Van Laethem, Stephanie Wuyts, Sven Van Laere, Silke Dirkx, Lucie Seyler, Rembert Mertens, Bart Ilsen, Patrick Lacor, Denis Pierard, Sabine D Allard

Abstract

Introduction: Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19.

Methods: In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis.

Results: Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as 'appropriate'). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis.

Conclusion: In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19.

Trial registration: The study is registered at ClinicalTrials.gov (NCT04544072).

Keywords: Antibiotics; Antimicrobial stewardship; Bacterial respiratory tract infection; COVID-19; Co-infection; Superinfection.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Schematic overview of patient inclusion and follow-up
Fig. 2
Fig. 2
Flow chart of the included admissions with a presumed COVID-19 diagnosis admitted to the COVID-19 ward in UZ Brussel
Fig. 3
Fig. 3
Appropriateness of antibiotic consumption in bacterial respiratory tract infection

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