COVID-19 Hospitalizations Spark Overuse of Antibiotic Concerns

A recent Pew Charitable Trusts study found that over half (52 percent) of COVID-19 hospitalizations during the first six months of the pandemic included antibiotic prescribing.  

Healthcare providers commonly prescribe antibiotics for coronavirus patients to treat potential secondary bacterial infections, even before diagnostic tests can confirm an infection. This has caused researchers to question whether the use of antibiotics among hospitalized COVID-19 patients in the early part of the pandemic was appropriate.

Researchers used IBM Watson Health’s electronic health records database to obtain data from nearly 5,000 patients and 6,000 hospital admissions from February to July 2020. The antibiotics studied included azithromycin, ceftriaxone, vancomycin, and piperacillin/tazobactam. 

Out of 5,838 unique hospital admissions in the study, 36 percent of admissions resulted in a patient being prescribed multiple antibiotics during hospitalization. 

But just 20 percent of patients admitted with COVID-19 were actually diagnosed with suspected or confirmed bacterial pneumonia, while nine percent were diagnosed with community-acquired urinary tract infection.

And in 96 percent of admissions, the patient received the first antibiotic at admission or within the first 48 hours of hospitalization, otherwise known as empiric prescribing. Researchers found a notable disparity between the percentage of patients who received antibiotics and those who were actually diagnosed with bacterial infections. 

Although empiric prescribing can help to ensure that patients with active infection receive antibiotics in a timely manner, it could also expose patients to antibiotics unnecessarily. 

Researchers explained that this unnecessary prescribing was likely due to challenges in differentiating between COVID-19 pneumonia and bacterial pneumonia, concerns that patients might have bacterial co-infections, and limited understanding about managing COVID-19 patients during the early phases of the pandemic.

They also found that patients who received antibiotics were more likely to have a longer hospitalization. Specifically, 60 percent of admissions with an antibiotic prescription lasted four or more days, while only 20 percent of admissions without an antibiotic prescribed lasted for the same amount of time.  

Antibiotic stewardship programs are designed to promote the appropriate use of antimicrobials, including antibiotics. The programs help to improve patient outcomes, reduce microbial resistance, and decrease the spread of infections. 

Antibiotic stewardship programs are required for most hospitals by regulatory and accreditation organizations. These programs can also play a critical role in helping healthcare providers reduce inappropriate prescribing that is associated with COVID-19. 

It is crucial that these programs have necessary resources so that physicians have access to information and guidance needed to make the best overall treatment decisions, according to researchers. 

One key aspect of antibiotic stewardship programs in hospitals, according to researchers, is de-escalation. De-escalation ensures that patients who were started on antibiotics are taken off them if results show they don’t have a bacterial infection. 

Throughout the years, experts have voiced the growing threat of antibiotic-resistant bacteria. The more antibiotics that are used, the faster the bacteria evolve to resist them. This makes it difficult or impossible to treat with existing drugs.

But decreasing incidences of empiric prescribing would help to slow the spread of these pathogens. 

A 2019 National Institutes of Health (NIH) study found that nearly 50 percent of antibiotics are inappropriately prescribed. 

But the study concluded that comprehensive programs consisting of provider and patient education, along with regular feedback, reduced the rate of inappropriate antibiotic prescribing and resulted in an overall decrease in outpatient antibiotic prescriptions. 

After just one year of biweekly reports providing normative comparison, inappropriate antibiotic usage decreased 40 percent, from 51.9 percent to 31 percent. The control group decreased just seven percent.