ABSTRACT
Recent reports have shown that antibiotics were commonly prescribed in COVID-19 designated hospitals throughout the pandemic in spite of it being ineffective in treating viruses such as SARS-COV 2 which is the pathogen responsible for causing COVID-19. We conducted a cross-sectional Point Prevalence Survey (PPS) involving all wards in Hospital Sungai Buloh. Each ward was audited within one day within the period of two weeks (1st December 2021 till 14th December 2021). All in-patients receiving IV or oral antibiotics at 8am on the day of survey were included in the study. A total of 200 out of 664 in-patients (30%) were treated with antibiotics during the study period. COVID ICU recorded the highest prevalence of patient on antibiotics (83%) followed by General Medical (43%). Majority of patients received antibiotics for empirical therapy (80%, 160/200) and community-acquired pneumonia was the most common indication documented (36.5%, 75/205), followed by hospital-acquired pneumonia, with 23.4% of total documented indication (48/205). We found that in half of the patients (104/200), clinicians did not document the indication of antibiotic. Rate of prescription that was compliant to guideline was higher than that of non-compliant to guideline from total of 139 cases recorded (68% vs 32%). We found that there was a significant association between rate of compliant to guideline with respiratory diseases (χ² = 5.37, p<0.05). Twenty-seven percent of patients received antibiotics for respiratory diseases not according to guideline recommendation. Majority of cases of non-compliance to guideline, were patient with respiratory diseases (58.7%, 27 out of 46 cases). This pandemic has had an impact on the use of antibiotics, where its use has been found to increase drastically, especially in critical and severe patients. This high use makes adherence to the guidelines become important and should be an ongoing indicator, also it can be used as a guide for antimicrobial stewardship intervention. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Intro Current evidence is still lacking in use of baricitinib among COVID-19 patients that require low flow oxygen and have systemic inflammation. Therefore, we are keen to evaluate the efficacy of baricitinib therapy among this group of patients, in preventing progression into high flow oxygen devices, mechanical ventilation and reducing mortality. Methods All hospitalised COVID-19 patients that required low flow oxygen with evidence of elevated inflammatory markers (either CRP > 50mg/L or ferritin > 500 mcg/L) were enrolled. It compared those that received standard of care (SOC) between April 2021 and May 2021, with another cohort of patients that received baricitinib and SOC between August 2021 and September 2021. Statistics were propensity score matched for age, gender, comorbidities, oxygen level, CRP and SPO2/FiO2 ratio. Findings Five-hundred fifty patients were included in the standard of care arm (SOC, n=275) and baricitinib-treated arm (BCT-SOC, n=275). Subjects in baricitinib-treated arm received a median 7 days of baricitinib. There was a significant reduction in the need for mechanical ventilation with baricitinib- treated arm compared with SOC arm (11.3% [31/275] BCT-SOC, 18.9% [52/275] SOC;HR 0.55, 95%CI 0.35-0.86;p=0.009). We found more patients in baricitinib- treated arm progressed into non-invasive ventilation or other high flow oxygen devices (26.9% [74/275] BCT-SOC, 19.6% [54/275] SOC;HR 1.45, 95%CI 1.02- 1.46;p=0.037). There was no significant difference in 28-day mortality among 2 groups (8% [22/275] BCT-SOC, 6.9% [19/275] SOC, HR 1.16, 95%CI 0.63-2.1;p=0.646). Discussion In our cohort of COVID-19 patients that require low flow oxygen and have systemic inflammation, a short course of baricitinib used in conjunction with SOC reduced needs of mechanical ventilation. This could help relieve our intensive care burden during COVID-19 crisis. Conclusion Despite showing reduced needs of invasive ventilation, it did not translate into mortality benefits. Thus, prospective randomized study is required to determine the optimal timing for initiation of baricitinib.