Patients hospitalized with COVID-19 receive unnecessary antibiotics, study finds
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Key takeaways:
- The incidence of secondary bacterial infection is moderate among patients hospitalized with COVID-19.
- Some patients received antibiotics for suspected secondary infections but may not have needed them.
Researchers found that patients hospitalized with COVID-19 received antibiotics for potential secondary bacterial infections without clinical indications suggesting they could benefit from the treatment.
“Our main goal of this study was to investigate how often patients presenting with COVID-19 [who] require hospitalization also have a secondary bacterial infection,” Hiromichi S. Park, DO, physician at Oregon Health & Science University, told Healio.
“COVID-19 can present similarly to bacterial pneumonia, [for] which clinicians are inclined to prescribe antibiotics and contribute to its overuse. We also investigated any key risk factors among those with secondary infections in order to aid clinicians identify which patients with COVID-19 have a predilection for having secondary bacterial infections,” Park said.
To assess rates of secondary bacterial infection among patients hospitalized with COVID-19, Park and colleagues performed a single-center retrospective cohort study of symptomatic inpatients admitted for COVID-19 between April 15, 2020, and June 30, 2021, and an academic quaternary-care referral center in Portland, Oregon.
All patients aged 18 years and older with a positive COVID-19 PCR test up to 10 days before admission were included in the study. Secondary infections were identified based on clinical, radiographic and microbiologic data, and logistic regression was used to identify risk factors for secondary infection.
In total, 118 patients were included — 31 (26.3%) of whom had either culture-proven (n = 15) or possible secondary (n = 16) infections.
The study demonstrated that mortality was higher among patients with secondary infections (35.5%) — which were primarily bacterial pneumonias (81.3%) — compared with those without secondary infection (4.6%).
According to the study, adverse outcomes including mortality (35.5% vs. 4.6%), length of stay (10 to 24 days vs. 6 to 15 days) and ICU admission (83.9% vs. 28.7%) were higher among patients with secondary infection compared with those without.
Additionally, empiric antibiotic use on admission was high among patients with secondary infections and those without (71% and 48.3%). Among patients with possible secondary infections, most received ceftriaxone (66.7%) and azithromycin (66.7%) compared with those with proven secondary infection who receiving cefepime “with similar distribution of other antibiotic classes.”
In a multivariable logistic regression model, researchers were able to identify transfer from an outside hospital (adjusted OR = 5.34; 95% CI, 1.89-15.03), use of immunosuppressant drugs (aOR = 4.53; 95% CI, 1.45-14.22) and treatment with dexamethasone (aOR = 4.21; 95% CI, 1.01-17.57) as significant independent risk factors for secondary infection.
“This study demonstrates that there are several hospitalized patients with COVID-19 [who] are prescribed antibiotics which may not be indicated,” Park concluded. “Such hospitalized patients without any clinical evidence of secondary infections (those [who] lack fevers, leukocytosis or any other features of sepsis) are most likely not going to benefit with antibiotic therapy.”
Park added that other studies have demonstrated similar trends with a higher proportion of hospitalized patients with COVID-19 receiving antibiotics compared with the rate of identified secondary infections, whereas additional studies are also surveying various cohorts in identifying additional risk factors in order to determine who are at a higher risk for developing secondary bacterial infections.
“Such studies can hopefully improve identifying secondary infections and improve antibiotic stewardship efforts.,” he said.
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