Limited Role for Antibiotics in COVID-19: Scarce Evidence of Bacterial Coinfection

Abstract

Background: There is currently a paucity of data describing bacterial coinfections, related antibiotic prescribing patterns, and the potential role of antimicrobial stewardship in the care of patients infected with SARS-CoV-2. Methods: This prospective, observational study was conducted from March 10, 2020 to April 21, 2020 in admitted patients with confirmed COVID-19. Patients were included if ≥ 18 years old and admitted to the hospital for further treatment. Data was collected via chart review from the enterprise electronic health record database. Data collected include factors driving antibiotic choice, indication, and duration of therapy as well as microbiological data. Findings: Antibiotics were initiated on admission in 87/147 (59%) patients. Of these, 85/87 (98%) prescriptions were empiric. The most common indication for empiric antibiotics was concern for community-acquired pneumonia (76/85, 89%) with the most prescribed antibiotics being ceftriaxone and azithromycin. The median duration of antibiotic therapy was two days (interquartile range 1-5). No patients had a community-acquired bacterial respiratory coinfection, but 10/147 (7%) of patients were found to have concurrent bacterial infections from a non-respiratory source, and one patient was diagnosed with active pulmonary tuberculosis at the time of admission for COVID-19. Interpretation: Bacterial coinfection in patients with COVID-19 was infrequent. Antibiotics are likely unnecessary in patients with mild symptoms. There is little role for broad-spectrum antibiotics to empirically treat multidrug resistant organisms in patients with COVID-19, regardless of disease severity. Antimicrobial stewardship remains important in patients infected with SARS-CoV-2. Funding Statement: The authors received no funding for this work. Declaration of Interests: The authors report no relevant conflicts of interest. Ethics Approval Statement: The study was approved by the UTSW Medical Center institutional review board and informed consent was waived.