High rates of antibiotic prescriptions in children with COVID‐19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America

  1. Adriana Yock‐Corrales
  2. Jacopo Lenzi
  3. Rolando Ulloa‐Gutiérrez
  4. Jessica Gómez‐Vargas
  5. Omar Yassef Antúnez‐Montes
  6. Jorge Alberto Rios Aida
  7. Olguita del Aguila
  8. Erick Arteaga‐Menchaca
  9. Francisco Campos
  10. Fadia Uribe
  11. Andrea Parra Buitrago
  12. Lina Maria Betancur Londoño
  13. Martin Brizuela
  14. Danilo Buonsenso

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Abstract

Aim

This study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID‐19 or Multisystem Inflammatory Syndrome (MIS‐C).

Methods

Children <18 years‐old assessed in five Latin Americas countries with a diagnosis of COVID‐19 or MIS‐C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed.

Results

A total of 990 children were included: 921 (93%) with COVID‐19, 69 (7.0%) with MIS‐C. The prevalence of antibiotic use was 24.5% ( n  = 243). MIS‐C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X‐rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals.

Conclusion

Our study showed a high rate of antibiotic prescriptions in children with COVID‐19, in particular in those with severe disease or MIS‐C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID‐19 children.

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  1. Version published to 10.1111/apa.15847
  2. ScreenIT

    SciScore for 10.1101/2020.12.05.20243568: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was reviewed and approved by the CoviD in sOuth aMerIcaN children—study GrOup core group and approved by the Ethics Committee of the coordinating center and by each participating center (Mexico: COMINVETICA-30072020-CEI0100120160207; Colombia: PE-CEI-FT-06; Peru: No. 42-IETSI-ESSALUD-2020; Costa Rica: CEC-HNN-243-2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All data were analyzed using the Stata 15 software (StataCorp. 2017. Stata Statistical Software: Release 15.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations to address. We did not collect bacteria isolation and antibiotic sensitivities throughout the pandemic in the participating centers. Blood results, including inflammatory markers, were not collected. In addition, an independent expert did not assess the appropriateness of antibiotic prescription, nor the length of administration. Last, the reason for starting antibiotic was subjectively based on the evaluating clinician. The main reason for this approach was that Latin American clinicians are still struggling in the front-line, with hospitals having limited human resources to dedicate extra time for clinical research. Despite these limitations, this study provides the largest overview of antibiotic use in children with COVID-19 and MIS-C to date. In conclusion, our study showed a relatively high rate of antibiotic prescriptions in children with COVID-19 and in particular in those with severe disease or MIS-C. Importantly, we found a significant variation in reasons for prescriptions of antibiotics and type of chosen therapies, as well in hospital practices, highlighting current uncertainties and lack of guidelines for the recognition of bacterial infections in COVID-19 children. Prospective studies are urgently needed to provide better evidence on the recognition and management of bacterial infections in COVID-19 children, as well as to develop dedicated antimicrobial stewardship programs.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.12.05.20243568v1 on medRxiv