Antibiotic use in patients with Coronavirus disease 2019 (COVID-19): outcomes and associated factors

Acta Clin Belg. 2022 Jun;77(3):579-587. doi: 10.1080/17843286.2021.1916300. Epub 2021 Apr 26.

Abstract

Objectives: To characterise the factors, outcomes and infections associated with antibiotic use in COVID-19 patients.

Methods: Records of patients with RT-PCR-confirmed COVID-19, hospitalized at the CHU Charleroi (Belgium) between 11 March and 3 May 3 2020, were retrospectively reviewed. Factors associated with antibiotic treatment, outcomes and bacterial infections were analysed.

Results: Among the 164 hospitalized COVID-19 patients (median age 60.5 years [IQR] 46-79), twenty-five (15.2%) were admitted to the ICU. Twenty-six (15.9%) died in the hospital. One hundred (61%) received antibiotic treatment. Combination therapies with macrolides were more common in the early part of the study period (26/67, 38.8%). Twenty-eight patients (17.1%) had a confirmed infection, mostly of the urinary tract (18/28, 64.3%). Only 2 (1.2%) had a documented respiratory coinfection. Six of the 7 ICU infections (85.7%) were superinfections. Gram-negative bacteria were most frequently isolated. In multivariate analysis, six factors were associated with antibiotic use: being hospitalized in the ICU (OR: 4.59; 95% CI 1.07-19.71), age > 65 years (OR: 4.16; 95% CI 1.72-10.05), arrival from a nursing home (OR: 4.59; 95% CI 1.11-19.71), diabetes (OR: 4.35; 95% CI 1.26-14.93), bilateral consolidation on chest CT (OR: 9.92; 95% CI 2.40-41.06) and a C-reactive protein level > 60 mg/L (OR:2.46; 95% CI 1.13-5.37). Antibiotic treatment did not reduce the length of stay or the mortality rate.

Conclusion: Antibiotics have been overused during the COVID-19 pandemic, despite a low rate of coinfections . Integrating the antimicrobial stewardship (AMS) programme into the COVID-19 response is essential.

Keywords: Antimicrobial stewardship; antibiotic use; coinfections; coronavirus disease 2019.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • COVID-19 Drug Treatment*
  • Coinfection* / drug therapy
  • Coinfection* / epidemiology
  • Coinfection* / microbiology
  • Humans
  • Middle Aged
  • Pandemics
  • Retrospective Studies
  • SARS-CoV-2

Substances

  • Anti-Bacterial Agents