Study: High antibiotic use in COVID patients with no co-infections
Nearly two thirds of COVID-19 patients without bacterial or fungal co-infections in Michigan hospitals received antibiotics during the first wave of the pandemic, University of Michigan researchers reported today in Infection Control & Hospital Epidemiology.
Of the 2,205 patients hospitalized for COVID-19 at 38 Michigan hospitals from Mar 16 through Aug 14, 2020, 141 (6.4%) had a co-infection; 3.0% were community-onset infections, and 3.4% were hospital-acquired. Among those with community-onset co-infection, 49.3% had respiratory infections, and 50.7% had bloodstream infections, while 77.2% of hospital-acquired infections were respiratory, and 22.8% were bloodstream infections. Among the patients with no co-infection, 64.9% received an antibiotic during hospitalization or at discharge.
Assessment of predictors for co-infection found that admission from a long-term care facility (odds ratio [OR], 3.98; 95% confidence interval [CI], 2.34 to 6.76) and admission to intensive care (OR, 4.34; 95% CI, 2.87 to 6.65) were associated with increased risk of community-onset infection. Hospital-acquired co-infection predictors included fever (OR, 2.46; 95% CI, 1.15 to 5.27) and advanced respiratory support (OR, 40.72; 95% CI, 13.49 to 122.93). Both community-onset and hospital-acquired co-infection were associated with higher in-hospital and 60-day mortality.
The findings are in line with previous studies from several countries that have found high rates of antibiotic use in COVID-19 patients, despite low prevalence of co-infection.
The study authors say knowing the incidence and predictors of community-acquired and hospital-onset infections could help efforts to reduce unnecessary antibiotic use in COVID-19 patients.
“Interventions reducing unnecessary antibiotics in COVID-19 patients could potentially reduce the global emergence of multidrug resistant organisms, adverse events such as renal injury, and even mortality,” they wrote.
Jul 26 Infect Control Hosp Epidemiol abstract
Study highlights need for better antibiotic stewardship at discharge
A review of electronic health records at three Indiana hospitals found patients receiving prolonged courses of antibiotic therapy for common types of infections, researchers reported last week in Open Forum Infectious Diseases.
The review, conducted from January through June 2019, looked at all adult patients who began antibiotic therapy at the hospitals and continued antibiotic therapy after discharge, focusing on patients with skin/soft tissue infection (SSTI), urinary tract infection (UTI), community-acquired pneumonia (CAP), or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days of therapy (DOT) for each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT for each patient.
Of the 547 patients included in the review, 233 (42.6%) had CAP, 120 (21.9%) had uncomplicated UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days, with a median duration of 9 days for CAP (4 days longer than recommended minimum treatment), 8 days for UTI (3 to 5 days longer), 12 days for SSTI (5 to 7 days longer), and 7 days for AECOPD (2 to 4 days longer). The most common antibiotics prescribed at discharge were cephalosporins, amoxicillin/clavulanate, and fluoroquinolones.
The authors say it is essential that clinicians account for DOT completed during hospital admission to determine the remaining DOT necessary following discharge and prevent excessive antibiotic durations. “Transitions of care remain an area for improvement for hospital antibiotic stewardship programs,” they wrote.
Jul 24 Open Forum Infect Dis abstract