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Review
. 2024 Jun 11;6(3):dlae093.
doi: 10.1093/jacamr/dlae093. eCollection 2024 Jun.

Antibiotic prescribing and bacterial infection in COVID-19 inpatients in Southeast Asia: a systematic review and meta-analysis

Achiraya Chanapal  1   2 , Hung-Yung Cheng  1 , Helen Lambert  1 , Wenjuan Cong  1
Affiliations
Review

Antibiotic prescribing and bacterial infection in COVID-19 inpatients in Southeast Asia: a systematic review and meta-analysis

Achiraya Chanapal et al. JAC Antimicrob Resist. .

Abstract

Background: The prescribing of antibiotics to treat COVID-19 patients has been observed to occur frequently, often without clear justification. This trend raises concerns that it may have exacerbated antimicrobial resistance (AMR). Despite longstanding concerns over AMR in Southeast Asian countries, data on this issue are notably lacking.

Objectives: To explore the impact of COVID-19 on antibiotic prescribing, bacterial infection prevalence and common resistant pathogens in COVID-19 inpatients.

Methods: We searched PubMed, EMBASE, Web of Science and ThaiJO (a Thai academic database) to identify studies conducted in ASEAN member countries and published between December 2019 and March 2023. Screening and data extraction were done by two independent reviewers, with results synthesized using random-effects meta-analyses and descriptive statistical analyses. This review was registered with PROSPERO (CRD42023454337).

Results: Of the 29 studies (19 750 confirmed COVID-19 cases) included for final analysis, the antibiotic prescribing rate was 62.0% (95%CI: 46.0%-76.0%) with a prescribing rate of 58.0% (21.0%-91.0%) in mild/moderate cases versus 91.0% (82.0%-98.0%) in severe/critical cases. Notably, 80.5% of antibiotics prescribed fall under the WHO AWaRe 'Watch' list, followed by 'Access' at 18.4% and 'Reserve' at 1.0%. The reported bacterial infection prevalence was 16.0% (7.0%-29.0%), with Acinetobacter baumannii being the most common resistant bacterium at 7.7%. Singapore was notable for its lower antibiotic prescribing rate of 17.0% and a lower bacterial infection rate of 10.0%.

Conclusions: High antibiotic prescribing rates, disproportionate to bacterial infections and varying practices for COVID-19 inpatients across countries highlight the urgent need for this region to collaborate to tackle and mitigate AMR.

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Figures

Figure 1.
Figure 1.
PRISMA 2020 flow diagram. From: Page et al. For more information, visit: http://www.prisma-statement.org/.
Figure 2.
Figure 2.
The prevalence of antibiotic prescribed in COVID-19 inpatients. H2 showed the proportion of variation due to heterogeneity, while τ2 estimated the variance of true effect sizes across studies.
Figure 3.
Figure 3.
Top 10 most frequently prescribed antibiotics for COVID-19 inpatients.
Figure 4.
Figure 4.
The prevalence of bacterial infection in COVID-19 inpatients. H2 showed the proportion of variation due to heterogeneity, while τ2 estimated the variance of true effect sizes across studies.
See this image and copyright information in PMC

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