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Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers

verfasst von: J. Van Laethem, S. Wuyts, S. Van Laere, J. Koulalis, M. Colman, M. Moretti, L. Seyler, E. De Waele, D. Pierard, P. Lacor, SD. Allard

Erschienen in: Internal and Emergency Medicine | Ausgabe 1/2022

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Abstract

This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th–May 4th, 2020), excluding short-term admissions (< 24 h). Antibiotic prescriptions were analyzed and quantified, using Defined Daily Doses (DDD) per admission and per 100 bed days. Possible drivers of antibiotic prescribing were identified by means of mixed effects logistic modelling analysis with backwards selection. Of all included admissions (n = 429), 39% (n = 171) were prescribed antibiotics for (presumed) respiratory tract superinfection (3.6 DDD/admission; 31.5 DDD/100 bed days). Consumption of beta-lactamase inhibitor–penicillin combinations was the highest (2.55 DDD/admission; 23.3 DDD/100 bed days). Four drivers were identified: fever on admission (OR 2.97; 95% CI 1.42–6.22), lower SpO₂/FiO₂ ratio on admission (OR 0.96; 95% CI 0.92–0.99), underlying pulmonary disease (OR 3.04; 95% CI 1.12–8.27) and longer hospital stay (OR 1.09; 95% CI 1.03–1.16). We present detailed quantitative antibiotic data for presumed respiratory tract superinfections in hospitalized COVID-19 patients. In addition to knowledge on antibiotic consumption, we hope antimicrobial stewardship programs will be able to use the drivers identified in this study to optimize their interventions in COVID-19 wards.

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Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE (2017) Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 177(9):1308–1315. https://doi.org/10.1001/jamainternmed.2017.1938CrossRefPubMedPubMedCentral

Spernovasilis NA, Kofteridis DP (2020) COVID-19 and antimicrobial stewardship: what is the interplay? Infect Control Hosp Epidemiol. https://doi.org/10.1017/ice.2020.246CrossRefPubMedPubMedCentral

Miranda C, Silva V, Capita R, Alonso-Calleja C, Igrejas G, Poeta P (2020) Implications of antibiotics use during the COVID-19 pandemic: present and future. J Antimicrob Chemother. https://doi.org/10.1093/jac/dkaa350CrossRefPubMedPubMedCentral

Rawson TM, Moore LSP, Castro-Sanchez E, Charani E, Davies F, Satta G, Ellington MJ, Holmes AH (2020) COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother 75(7):1681–1684. https://doi.org/10.1093/jac/dkaa194CrossRefPubMed

Antimicrobial resistance in the age of COVID-19 (2020). Nat Microbiol 5(6):779. https://doi.org/10.1038/s41564-020-0739-4(Editorial)

Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, Fernandez-Pittol M, Pitart C, Inciarte A, Bodro M, Morata L, Ambrosioni J, Grafia I, Meira F, Macaya I, Cardozo C, Casals C, Tellez A, Castro P, Marco F, García F, Mensa J, Martínez JA, Soriano A (2020) Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2020.07.041CrossRefPubMedPubMedCentral

Lansbury L, Lim B, Baskaran V, Lim WS (2020) Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect 81(2):266–275. https://doi.org/10.1016/j.jinf.2020.05.046CrossRefPubMedPubMedCentral

Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP (2020) Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect 26(10):1395–1399. https://doi.org/10.1016/j.cmi.2020.06.025CrossRefPubMedPubMedCentral

Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, Soucy JR, Daneman N (2020) Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2020.07.016CrossRefPubMedPubMedCentral

10.

Klein EY, Monteforte B, Gupta A, Jiang W, May L, Hsieh Y-H, Dugas A (2016) The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses 10(5):394–403. https://doi.org/10.1111/irv.12398CrossRefPubMedPubMedCentral

11.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England) 395(10229):1054–1062. https://doi.org/10.1016/s0140-6736(20)30566-3CrossRefPubMed

12.

Festic E, Bansal V, Kor DJ, Gajic O (2015) SpO2/FiO2 ratio on hospital admission is an indicator of early acute respiratory distress syndrome development among patients at risk. J Intensive Care Med 30(4):209–216. https://doi.org/10.1177/0885066613516411CrossRefPubMed

13.

World Health Organization (WHO) collaborating centre for drugs statistics methodology (2020) DDD and ATC-classification. WHO collaborating centre for drugs statistics methodology. https://www.whocc.no/atc_ddd_index/. Accessed 11 Nov 2020

14.

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, Doudier B, Courjon J, Giordanengo V, Vieira VE, Tissot Dupont H, Honoré S, Colson P, Chabrière E, La Scola B, Rolain JM, Brouqui P, Raoult D (2020) Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 56(1):105949. https://doi.org/10.1016/j.ijantimicag.2020.105949CrossRefPubMedPubMedCentral

15.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

16.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche J-D, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent J-L, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315(8):801–810. https://doi.org/10.1001/jama.2016.0287CrossRefPubMedPubMedCentral

17.

Beović B, Doušak M, Ferreira-Coimbra J, Nadrah K, Rubulotta F, Belliato M, Berger-Estilita J, Ayoade F, Rello J, Erdem H (2020) Antibiotic use in patients with COVID-19: a “snapshot” infectious diseases international research initiative (id-iri) survey. J Antimicrob Chemother 75(11):3386–3390. https://doi.org/10.1093/jac/dkaa326CrossRefPubMed

18.

Ginsburg AS, Klugman KP (2020) COVID-19 pneumonia and the appropriate use of antibiotics. Lancet Glob Health 8(12):e1453–e1454. https://doi.org/10.1016/S2214-109X(20)30444-7CrossRefPubMedPubMedCentral

19.

Furukawa D, Graber CJ (2020) Antimicrobial stewardship in a pandemic: picking up the pieces. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1273CrossRef

20.

Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J (2020) COVID-19: don’t neglect antimicrobial stewardship principles! Clin Microbiol Infect 26(7):808–810. https://doi.org/10.1016/j.cmi.2020.04.024CrossRefPubMedPubMedCentral

21.

Karami Z, Knoop BT, Dofferhoff ASM, Blaauw MJT, Janssen NA, van Apeldoorn M, Kerckhoffs APM, van de Maat JS, Hoogerwerf JJ, Ten Oever J (2020) Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands. Infect Dis (Lond). https://doi.org/10.1080/23744235.2020.1839672CrossRefPubMed

22.

Bassetti M, Kollef MH, Timsit JF (2020) Bacterial and fungal superinfections in critically ill patients with COVID-19. Intensive Care Med 46(11):2071–2074. https://doi.org/10.1007/s00134-020-06219-8CrossRefPubMedPubMedCentral

23.

Pouw N, van de Maat J, Veerman K, Ten Oever J, Janssen N, Abbink E, Reijers M, de Mast Q, Hoefsloot W, van Crevel R, Slieker K, van Apeldoorn M, Blaauw M, Dofferhoff A, Hoogerwerf J (2021) Clinical characteristics and outcomes of 952 hospitalized COVID-19 patients in The Netherlands: a retrospective cohort study. PLoS ONE 16(3):e0248713. https://doi.org/10.1371/journal.pone.0248713CrossRefPubMedPubMedCentral

24.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J, Wang S, Chao Y, Yang Z, Xu J, Zhou X, Chen D, Xiong W, Xu L, Zhou F, Jiang J, Bai C, Zheng J, Song Y (2020) Risk Factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 180(7):934–943. https://doi.org/10.1001/jamainternmed.2020.0994CrossRefPubMed

25.

Vaughn VM, Gandhi T, Petty LA, Patel PK, Prescott HC, Malani AN, Ratz D, McLaughlin E, Chopra V, Flanders SA (2020) Empiric Antibacterial therapy and community-onset bacterial co-infection in patients hospitalized with covid-19: a multi-hospital cohort study. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1239CrossRefPubMedPubMedCentral

26.

European Centre for Disease Prevention and Control (2020) Antimicrobial resistance in the EU/EEA (EARS-Net). Annual Epidemiological Report 2019. Stockholm

27.

Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O’Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL (2016) Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American Thoracic Society. Clin Infect Dis 63(5):e61–e111. https://doi.org/10.1093/cid/ciw353CrossRefPubMedPubMedCentral

28.

Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Li Bassi G, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R (2017) International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. https://doi.org/10.1183/13993003.00582-2017CrossRefPubMed

29.

Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK (2013) Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest 144(6):1759–1767. https://doi.org/10.1378/chest.13-0076CrossRefPubMed

30.

Pugh R, Grant C, Cooke RP, Dempsey G (2015) Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007577.pub3CrossRefPubMedPubMedCentral

31.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG (2019) Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 200(7):e45–e67. https://doi.org/10.1164/rccm.201908-1581STCrossRefPubMedPubMedCentral

32.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England) 395(10223):507–513. https://doi.org/10.1016/s0140-6736(20)30211-7CrossRefPubMed

33.

Wu J, Liu J, Zhao X, Liu C, Wang W, Wang D, Xu W, Zhang C, Yu J, Jiang B, Cao H, Li L (2020) Clinical characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu province: a multicenter descriptive study. Clin Infect Dis 71(15):706–712. https://doi.org/10.1093/cid/ciaa199CrossRefPubMed

34.

Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129(6):433–440. https://doi.org/10.7326/0003-4819-129-6-199809150-00002CrossRefPubMed

35.

Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Verheij TJ (2005) Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 26(6):1138–1180. https://doi.org/10.1183/09031936.05.00055705CrossRefPubMed

36.

Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L (2015) Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 373(5):415–427. https://doi.org/10.1056/NEJMoa1500245CrossRefPubMedPubMedCentral

37.

Almirall J, Serra-Prat M, Bolíbar I, Balasso V (2017) Risk factors for community-acquired pneumonia in adults: a systematic review of observational studies. Respiration 94(3):299–311. https://doi.org/10.1159/000479089CrossRefPubMed

38.

Wong HYF, Lam HYS, Fong AH, Leung ST, Chin TW, Lo CSY, Lui MM, Lee JCY, Chiu KW, Chung TW, Lee EYP, Wan EYF, Hung IFN, Lam TPW, Kuo MD, Ng MY (2020) Frequency and distribution of chest radiographic findings in patients positive for COVID-19. Radiology 296(2):E72-e78. https://doi.org/10.1148/radiol.2020201160CrossRefPubMed

39.

Kanne JP, Little BP, Chung JH, Elicker BM, Ketai LH (2020) Essentials for radiologists on COVID-19: an update-radiology scientific expert panel. Radiology 296(2):E113-e114. https://doi.org/10.1148/radiol.2020200527CrossRefPubMed

40.

Pan F, Ye T, Sun P, Gui S, Liang B, Li L, Zheng D, Wang J, Hesketh RL, Yang L, Zheng C (2020) Time course of lung changes at chest ct during recovery from coronavirus disease 2019 (COVID-19). Radiology 295(3):715–721. https://doi.org/10.1148/radiol.2020200370CrossRefPubMed

41.

Balligand E, Costers M, Van Gastel E (2014) Belgian antibiotic policy coordination committee beleidsnota legislatuur 2014–2019. Online beleidsdocument: https://overlegorganen.gezondheid.belgie.be/nl/documenten/beleidsnota-bapcoc-2014-2019

42.

Lam SW, Bauer SR, Fowler R, Duggal A (2018) Systematic review and meta-analysis of procalcitonin-guidance versus usual care for antimicrobial management in critically ill patients: focus on subgroups based on antibiotic initiation, cessation, or mixed strategies. Crit Care Med 46(5):684–690. https://doi.org/10.1097/ccm.0000000000002953CrossRefPubMed

43.

Vanhomwegen C, Veliziotis I, Malinverni S, Konopnicki D, Dechamps P, Claus M, Roman A, Cotton F, Dauby N (2021) Procalcitonin accurately predicts mortality but not bacterial infection in COVID-19 patients admitted to intensive care unit. Ir J Med Sci. https://doi.org/10.1007/s11845-020-02485-zCrossRefPubMedPubMedCentral

44.

May M, Chang M, Dietz D, Shoucri S, Laracy J, Sobieszczyk ME, Uhlemann AC, Zucker J, Kubin CJ (2021) Limited utility of procalcitonin in identifying community-associated bacterial infections in patients presenting with coronavirus disease 2019. Antimicrob Agents Chemother. https://doi.org/10.1128/aac.02167-20CrossRefPubMedPubMedCentral

Titel: Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers
verfasst von: J. Van Laethem
S. Wuyts
S. Van Laere
J. Koulalis
M. Colman
M. Moretti
L. Seyler
E. De Waele
D. Pierard
P. Lacor
SD. Allard
Publikationsdatum: 29.06.2021
Verlag: Springer International Publishing
Schlagwort: COVID-19
Erschienen in: Internal and Emergency Medicine / Ausgabe 1/2022
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-021-02790-0

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