Introduction

Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19.

Methods

In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis.

Results

Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis.

Conclusion

In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19.

Trial Registration

The study is registered at ClinicalTrials.gov (NCT04544072).

中文翻译：

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针对 COVID-19 入院患者细菌性呼吸道感染的抗生素处方：一项前瞻性观察研究

介绍

尽管 COVID-19 患者很少出现细菌共感染和重复感染，但住院患者的总体抗生素处方很高。为了应对抗生素过度处方，抗生素管理团队需要有关 COVID-19 入院患者抗生素处方的可靠数据。

方法

在这项前瞻性观察性队列研究中，我们对 2020 年 5 月 1 日至 11 月 2 日期间入住拥有 721 个床位的比利时大学医院 COVID-19 病房的患者的抗生素处方进行了定量和定性评估。人口统计学、临床和微生物学参数的数据并收集抗生素消耗量。计算在（假定的）细菌性呼吸道感染情况下开具的抗生素的确定日剂量 (DDD)，并将其转换为两个指标：DDD/入院和 DDD/100 个住院天数。一个传染病专家团队对每个处方进行了适当性评估。进行了一项驱动程序分析，以确定增加确诊 COVID-19 患者抗生素处方几率的因素。

结果

在 403 名疑似 COVID-19 感染的合格参与者中，包括 281 名。在 203 例确诊为 COVID-19 的入院患者中，有 13.8% 的患者因（假定的）细菌性呼吸道合并/重复感染开始使用抗生素（0.86 DDD/入院；8.92 DDD/100 个床日；39.4% 被评分为“适当” '）。确定了抗生素处方的五个驱动因素：脑血管疾病史、男性患者中性粒细胞/淋巴细胞比率高、年龄、铁蛋白水平升高以及收集呼吸道样本进行细菌学分析。

结论

在所研究的人群中，（假定的）细菌呼吸道合并/重复感染的抗生素消耗量很低。特别是，确诊为 COVID-19 的患者中 DDD 的总数很少，这表明抗生素的使用是经过深思熟虑的。然而，抗生素管理计划对于应对 COVID-19 住院患者不必要和不适当的抗生素使用仍然至关重要。

试用注册

该研究已在 ClinicalTrials.gov (NCT04544072) 上注册。