Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey

Abstract

Background: Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection.

Objectives: To investigate antibiotic prescribing practices in patients with COVID-19.

Methods: We performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis.

Results: The survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of β-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days.

Conclusions: The study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.

Figure 1.

Percentage of participants prescribing the given group of antibiotics on the ward. Multiple-response categorical variables (up to two responses). Darker colours indicate higher percentages. *USA and Canada.

Figure 2.

Percentage of participants prescribing the given group of antibiotics in the ICU. Multiple-response categorical variables (up to two responses). Darker colours indicate higher percentages. *USA and Canada. **‘Other’ groups of antibiotics prescribed in North America: azithromycin, vancomycin, cefepime+linezolid, ceftriaxone+azithromycin and vancomycin+cefepime.