Abstract
The role of antibiotics in the treatment in COVID-19 cases has not yet been adequately defined, and no criteria have been established for antibiotic treatment, type and duration. This paper reports the results of an observational study on the extent of antibiotic use in 52 randomly selected patients in the intensive care unit (ICU) at the University Hospital in Pristina, Kosovo with severe forms of COVID-19. Antibiotics were prescribed in all the cases (52; 100%). Of the 52 patients, 1) 13 (25%) were given antibiotics before hospitalisation, 2) 49 (94.2%) during treatment in the ward and 3) 52 (100%) during treatment in the ICU. Most often, empirical antibiotics were administered in 32 cases (61.5%) to treat methicillin resistant Staphylococcus aureus (MRSA) infections, and in 23 patients (44.2%) to treat atypical pathogens. The most prescribed antibiotics were ceftriaxone/cefotaxime plus macrolide in (17 cases; 32.7%), ceftriaxone/cefotaxime in (15 cases; 28.8%), ampicillin/amoxicillin plus clavulanic acid or sulbactam (five cases; 9.6%), and quinolones (five cases; 9.6%). Imipenem was the most frequently used antibiotic in the ICU (30 cases; 57.7%), followed by ceftriaxone (28 cases; 53.8%), and piperacillin/tazobactam and fluoroquinolone (17 cases; 32.7%). In 18 cases (34.6%), three antibiotics were given simultaneously; two antibiotics in 29 cases (55.8%) and in five cases (9.6%) only one antibiotic was given. The mean duration of antibiotic treatment was 12.71 days (3-22 days; SD 4.026). The study showed unrestricted use of broad-spectrum antibiotics in the treatment of severe cases with COVID-19.
Highlights
The role of antibiotics in the treatment in COVID-19 cases has not yet been adequately defined, and no criteria have been established for antibiotic treatment, type and duration
All 52 patients admitted to the ICU had laboratory biological data on leukocytes, lymphocytes, and platelets, C-reactive protein (CRP) was available for 50 patients (96.2%), procalcitonin (PCT) was available for 14 patients (27%), and fibrinogen was available for seven patients (13.5%)
All patients were placed on oxygen therapy; 14 (26.9%) of them were on continuous positive airway pressure therapy (CPAP) and 29 patients (55.8%) were on mechanical ventilation
Summary
The role of antibiotics in the treatment in COVID-19 cases has not yet been adequately defined, and no criteria have been established for antibiotic treatment, type and duration. Methodology: This paper reports the results of an observational study on the extent of antibiotic use in 52 randomly selected patients in the intensive care unit (ICU) at the University Hospital in Pristina, Kosovo with severe forms of COVID-19. Conclusions: The study showed unrestricted use of broad-spectrum antibiotics in the treatment of severe cases with COVID-19. The precise incidence of bacterial superinfection in COVID-19 patients is unknown but appears to be much lower than in severe influenza cases [4,5,6]. Most studies report initial co-infection or secondary bacterial pneumonia (11-35% of cases) in hospitalised patients caused primarily by Streptococcus pneumoniae and Staphylococcus aureus [5]. Co-infection rates increased in critically ill patients admitted to the ICU globally [7]. The rationale for antibiotic treatment in COVID-19 patients appears to be based on experience with bacterial superinfection in influenza.
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