Antibiotic Use and Associated Risk Factors for Antibiotic Prescribing in COVID-19 Hospitalized Patients

  1. Alysa J. Martin
  2. Stephanie Shulder
  3. David Dobrzynski
  4. Katelyn Quartuccio
  5. Kelly E. Pillinger

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Abstract

Literature suggests that antibiotic prescribing in COVID-19 patients is high. Currently, there are insufficient data on what drives antibiotic prescribing practices throughout the COVID-19 pandemic.

Objective:

This study sought to determine antibiotic use rates and identify risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than 1 course of antibiotics.

Methods:

This was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020, to May 31, 2020, and treated for COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than 1 antibiotic course, and rate of microbiologically confirmed infections.

Results:

A total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least 1 course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than 1 course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than 1 course of antibiotics included increased hospital length of stay (median 12 days), intensive care unit admission, and the necessity for mechanical ventilation.

Conclusion and Relevance:

There were high rates of antibiotic prescribing with low rates of microbiologically confirmed bacterial co-infection. Many patients received more than 1 course of antibiotics during hospitalization. This study highlights the importance and demand for appropriate antibiotic stewardship practices in COVID-19 patients.

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  1. Version published to 10.1177/08971900211030248
  2. ScreenIT

    SciScore for 10.1101/2020.10.21.20217117: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was reviewed and deemed exempt by the Institutional Review Board.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    One limitation of this study is its retrospective design. Laboratory and microbiologic data collected were not consistent amongst all patients. We found duration of admission and ICU length of stay to be associated with higher antibiotic use, however it is difficult to say that these are true risk factors for antibiotic prescribing. Instead, this difference was likely due to antibiotic prescribing being higher in patients with more serious illness, and perhaps longer admission leading to increased risk of nosocomial infections and subsequent antibiotic courses. Additionally, we did not perform a time adjusted analysis. Another limitation is that the vast majority of patients within our study received antibiotics which could have affected our ability to detect differences between the two groups. Early in the pandemic, most COVID-19 patients within our institution received antibiotics. While we saw a temporal decrease over time, it is difficult to assess risk factors for antibiotic use in our patients treated for COVID-19 early in the study when antibiotic use was routine. While there were limitations of this study, there were also several strengths. This study was multi-site, including three hospitals within the University of Rochester Medical Center: two community hospitals and a tertiary academic medical center. Therefore, the results of this study may be generalizable to similar sites. Finally, as previously mentioned, this is the first study to assess overall antibiotic us...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.10.21.20217117 on medRxiv