Antimicrobial Use in Hospitalised Patients with COVID-19: An International Multicentre Point-Prevalence Study.

Lea Papst,Nina Gorišek Miksić,Omar Simonetti,Goran Stevanović,Zorana M Djordjevic,Biljana Carević,Davor Petek,Emanuela Sozio,Milica Lukić,Carlo Tascini,Bojana Beović,Roberto Luzzati,Vera Vlahović Palčevski

doi:10.3390/antibiotics11020176

Abstract

Studies suggest that the incidence of coinfections in patients with the coronavirus disease 2019 (COVID-19) is low, but a large number of patients receive antimicrobials during hospitalisation. This may fuel a rise in antimicrobial resistance (AMR). We conducted a multicentre point-prevalence survey in seven tertiary university hospitals (in medical wards and intensive care units) in Croatia, Italy, Serbia and Slovenia. Of 988 COVID-19 patients, 521 were receiving antibiotics and/or antifungals (52.7%; range across hospitals: 32.9–85.6%) on the day of the study. Differences between hospitals were statistically significant (χ2 (6, N = 988) = 192.57, p < 0.001). The majority of patients received antibiotics and/or antifungals within 48 h of admission (323/521, 62%; range across hospitals: 17.4–100%), their most common use was empirical (79.4% of prescriptions), and pneumonia was the main indication for starting the treatment (three-quarters of prescriptions). The majority of antibiotics prescribed (69.9%) belonged to the “Watch” group of the World Health Organization AWaRe classification. The pattern of antimicrobial use differed across hospitals. The data show that early empiric use of broad-spectrum antibiotics is common in COVID-19 patients, and that the pattern of antimicrobial use varies across hospitals. Judicious use of antimicrobials is warranted to prevent an increase in AMR.

Highlights

Licensee MDPI, Basel, Switzerland.Antimicrobial resistance (AMR) is an inevitable consequence of antimicrobial use, making antimicrobial stewardship (AMS) an irreplaceable tool in the fight against increasing resistance [1]
Amidst the ever-increasing threat of antimicrobial resistance (AMR), the coronavirus disease 2019 (COVID-19) pandemic has shifted the focus of healthcare providers to the care of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Use of antibiotics and antifungals was common in intensive care units (ICUs) (135/186, 72.6%; range across hospitals: 54.1–100%) as well as in medical wards (386/802, 48.1%; range across hospitals: 14.3–93.6%)

Summary

Introduction

Licensee MDPI, Basel, Switzerland.Antimicrobial resistance (AMR) is an inevitable consequence of antimicrobial use, making antimicrobial stewardship (AMS) an irreplaceable tool in the fight against increasing resistance [1]. Amidst the ever-increasing threat of AMR, the coronavirus disease 2019. (COVID-19) pandemic has shifted the focus of healthcare providers to the care of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bacterial coinfection has been reported in only 1.2–3.5% of patients with COVID-19 [3,4,5,6]. Bacterial or fungal infections have been identified in 6.9–8% of patients [7,8], with early bacterial coinfection being rare (3.5% of patients), and secondary bacterial/fungal infection occurring in 14.3% of patients [8]. Studies and systematic reviews reported the use of antimicrobials in up to 38.3–74.6% of patients [4,5,7,9,10]

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Conclusion