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Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands.
Karami, Zara; Knoop, Bram T; Dofferhoff, Anton S M; Blaauw, Marc J T; Janssen, Nico A; van Apeldoorn, Marjan; Kerckhoffs, Angèle P M; van de Maat, Josephine S; Hoogerwerf, Jacobien J; Ten Oever, Jaap.
  • Karami Z; Radboud University Medical Center, Nijmegen, The Netherlands.
  • Knoop BT; Radboud Center for Infectious diseases, Nijmegen, The Netherlands.
  • Dofferhoff ASM; Radboud University Medical Center, Nijmegen, The Netherlands.
  • Blaauw MJT; Radboud Center for Infectious diseases, Nijmegen, The Netherlands.
  • Janssen NA; Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
  • van Apeldoorn M; Radboud University Medical Center, Nijmegen, The Netherlands.
  • Kerckhoffs APM; Radboud Center for Infectious diseases, Nijmegen, The Netherlands.
  • van de Maat JS; Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
  • Hoogerwerf JJ; Bernhoven University, Uden, The Netherlands.
  • Ten Oever J; Radboud University Medical Center, Nijmegen, The Netherlands.
Infect Dis (Lond) ; 53(2): 102-110, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066202
ABSTRACT

BACKGROUND:

Knowledge on bacterial co-infections in COVID-19 is crucial to use antibiotics appropriately. Therefore, we aimed to determine the incidence of bacterial co-infections, antibiotic use and application of antimicrobial stewardship principles in hospitalized patients with COVID-19.

METHODS:

We performed a retrospective observational study in four hospitals (1 university, 2 non-university teaching, 1 non-teaching hospital) in the Netherlands from March to May 2020 including consecutive patients with PCR-confirmed COVID-19. Data on first microbiological investigations obtained at the discretion of the physician and antibiotic use in the first week of hospital admission were collected.

RESULTS:

Twelve (1.2%) of the 925 patients included had a documented bacterial co-infection (75.0% pneumonia) within the first week. Microbiological testing was performed in 749 (81%) patients sputum cultures in 105 (11.4%), blood cultures in 711 (76.9%), pneumococcal urinary antigen testing in 202 (21.8%), and Legionella urinary antigen testing in 199 (21.5%) patients, with clear variation between hospitals. On presentation 556 (60.1%; range 33.3-73.4%) patients received antibiotics for a median duration of 2 days (IQR 1-4). Intravenous to oral switch was performed in 41 of 413 (9.9%) patients who received intravenous treatment >48 h. Mean adherence to the local guideline on empiric antibiotic therapy on day 1 was on average 60.3% (range 45.3%-74.7%).

CONCLUSIONS:

On presentation to the hospital bacterial co-infections are rare, while empiric antibiotic use is abundant. This implies that in patients with COVID-19 empiric antibiotic should be withheld. This has the potential to dramatically reduce the current overuse of antibiotics in the COVID-19 pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bacterial Infections / Pandemics / Prescription Drug Overuse / COVID-19 / Anti-Bacterial Agents Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Infect Dis (Lond) Year: 2021 Document Type: Article Affiliation country: 23744235.2020.1839672

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bacterial Infections / Pandemics / Prescription Drug Overuse / COVID-19 / Anti-Bacterial Agents Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Infect Dis (Lond) Year: 2021 Document Type: Article Affiliation country: 23744235.2020.1839672