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. 2021 May 11;16(5):e0251340.
doi: 10.1371/journal.pone.0251340. eCollection 2021.

Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID

Jorge Calderón-Parra  1 , Antonio Muiño-Miguez  2 , Alejandro D Bendala-Estrada  2 , Antonio Ramos-Martínez  1 , Elena Muñez-Rubio  1 , Eduardo Fernández Carracedo  2 , Javier Tejada Montes  3 , Manuel Rubio-Rivas  4 , Francisco Arnalich-Fernandez  5 , Jose Luis Beato Pérez  6 , Jose Miguel García Bruñén  7 , Esther Del Corral Beamonte  8 , Paula Maria Pesqueira Fontan  9 , Maria Del Mar Carmona  10 , Rosa Fernández-Madera Martínez  11 , Andrés González García  12 , Cristina Salazar Mosteiro  13 , Carlota Tuñón de Almeida  14 , Julio González Moraleja  15 , Francesco Deodati  16 , María Dolores Martín Escalante  17 , María Luisa Asensio Tomás  18 , Ricardo Gómez Huelgas  19 , José Manuel Casas Rojo  16 , Jesús Millán Núñez-Cortés  2 ; SEMI-COVID-19 Network
Affiliations

Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID

Jorge Calderón-Parra et al. PLoS One. .

Abstract

Background: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use.

Methods: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified.

Results: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001).

Conclusion: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient flowchart.
Fig 2
Fig 2. Antibiotic prescription variation over time.
Abscissa axis corresponds to admission date. Ordinate axis corresponds to the percentage of patients with antibiotic prescription (scheme 0.9 equals to 90%). Data are shown for the period with more than 20 admissions per day.
See this image and copyright information in PMC

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