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

Knowledge on bacterial co-infections in COVID-19 is crucial to use antibiotics appropriately. Therefore, we aimed to determine the incidence of bacterial co-infections, antibiotic use and application of antimicrobial stewardship principles in hospitalized patients with COVID-19. We performed a retro...

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Published in:	Infectious diseases (London, England) Vol. 53; no. 2; pp. 102 - 110
Main Authors:	Karami, Zara, Knoop, Bram T., Dofferhoff, Anton S. M., Blaauw, Marc J. T., Janssen, Nico A., van Apeldoorn, Marjan, Kerckhoffs, Angèle P. M., van de Maat, Josephine S., Hoogerwerf, Jacobien J., ten Oever, Jaap
Format:	Journal Article
Language:	English
Published:	England Taylor & Francis 01-02-2021
Subjects:	Aged Anti-Bacterial Agents - administration & dosage antibiotic use Antimicrobial Stewardship bacterial co-infections Bacterial Infections - drug therapy Bacterial Infections - epidemiology Bacterial Infections - microbiology Blood Culture Coinfection COVID-19 COVID-19 - epidemiology COVID-19 - virology Drug Administration Routes Drug Administration Schedule Female Guideline Adherence - statistics & numerical data Hospitalization Humans Incidence Male Middle Aged Netherlands - epidemiology Pandemics pneumonia Prescription Drug Overuse - prevention & control Prescription Drug Overuse - statistics & numerical data Retrospective Studies SARS-CoV-2 SARS-CoV-2 - pathogenicity Netherlands COVID-19 antibiotic use SARS-CoV-2 antimicrobial stewardship bacterial co-infections pneumonia
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Summary:	Knowledge on bacterial co-infections in COVID-19 is crucial to use antibiotics appropriately. Therefore, we aimed to determine the incidence of bacterial co-infections, antibiotic use and application of antimicrobial stewardship principles in hospitalized patients with COVID-19. We performed a retrospective observational study in four hospitals (1 university, 2 non-university teaching, 1 non-teaching hospital) in the Netherlands from March to May 2020 including consecutive patients with PCR-confirmed COVID-19. Data on first microbiological investigations obtained at the discretion of the physician and antibiotic use in the first week of hospital admission were collected. Twelve (1.2%) of the 925 patients included had a documented bacterial co-infection (75.0% pneumonia) within the first week. Microbiological testing was performed in 749 (81%) patients: sputum cultures in 105 (11.4%), blood cultures in 711 (76.9%), pneumococcal urinary antigen testing in 202 (21.8%), and Legionella urinary antigen testing in 199 (21.5%) patients, with clear variation between hospitals. On presentation 556 (60.1%; range 33.3-73.4%) patients received antibiotics for a median duration of 2 days (IQR 1-4). Intravenous to oral switch was performed in 41 of 413 (9.9%) patients who received intravenous treatment >48 h. Mean adherence to the local guideline on empiric antibiotic therapy on day 1 was on average 60.3% (range 45.3%-74.7%). On presentation to the hospital bacterial co-infections are rare, while empiric antibiotic use is abundant. This implies that in patients with COVID-19 empiric antibiotic should be withheld. This has the potential to dramatically reduce the current overuse of antibiotics in the COVID-19 pandemic.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	2374-4235 2374-4243
DOI:	10.1080/23744235.2020.1839672