Microbiologic characterization and antibacterial use in hospitalized adults with COVID-19 infection

ABSTRACT

Background: Coronavirus disease 2019 (CoVID-19) admissions, oft complicated by an uncertain trajectory, lent to treatment influenced by supposition. Respiratory bacterial co-infection frequently was invoked. The purpose of this study was to determine the respiratory pathogen distribution and antibiotic prescribing patterns in hospitalized patients with CoVID-19. Methods: Patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ICD-10 code and/or positive polymerase chain reaction (PCR) hospitalized between March 1 and May 31, 2020 were included. Antibiotic utilization (patient days of therapy-pDOT) was collected for the institution during this period and two years prior. Respiratory microbiologic cultures were reviewed to examine the frequency of co-infection on presentation, categorized as within 3 calendar days from admission or afterward. The relationship of antibiotic utilization to positive cultures was also categorized. Results: Of the 7,969 encounters, 829 were ICD-10 coded and/or confirmed SARS-CoV-2 PCR positive and 196 (23.6%) had positive respiratory cultures. 89.8% of patients had endotracheal samples, the rest were isolated from sputum or bronchoalveolar lavage (17.4% and 6.6%, respectively). Patients were more likely to isolate commensal respiratory flora (108 versus 78 patients within the first 3 days of presentation. Notable isolates such as Staphylococcus aureus and Pseudomonas aeruginosa, were more often isolated after 3 days of hospitalization. While the CoVID-19 average hospital census was only 14.7% of the total, antibiotic utilization, (pDOT/1000) was 2.3 times higher, 831.9 versus 368.3 across the institution. During similar periods in 2018 and 2019, days of therapy overall were lower. For CoVID-19 infected patients, the frequency of antibiotic initiation was 73.2%. The length of therapy was on average 8 days with a high rate of observed restarts. Conclusion: Bacterial co-infection in an acute viral process is generally low. In this examination of CoVID-19 infected patients, the rate of any positive respiratory culture was 23.6%. A disproportionate effect on the volume of antibiotics and total days of therapy prompted an interest in early stewardship efforts and education. (Table Presented).