ADDRESSING EMPIRIC ANTIBIOTICS USAGE IN CORONAVIRUS DISEASE 2019 (COVID-19) PATIENTS

ABSTRACT

STATEMENT OF PROBLEM/QUESTION To review empiric antibiotic usage in COVID-19 patients and highlight the involvement of the antimicrobial stewardship (AMS) team to reduce unnecessary antibiotic days DESCRIPTION OF PROGRAM/INTERVENTION Majority of deaths during the H1N1 pandemic were attributed to secondary bacterial respiratory infections but data regarding superinfections in COVID-19 pneumonia is still emerging. During the COVID-19 pandemic, most physicians started empiric antibiotics in patients with COVID-19. We reviewed adult patients with COVID-19 admitted to Northwestern McHenry Hospital from November 2020 to January 2021. AMS team was actively involved in reviewing antibiotics and using electronic medical records (EMR) prompts and secure texting system to recommend discontinuation of antibiotics where there were no signs of bacterial infection. We also analyzed whether early discontinuation led to any adverse event/readmission. MEASURES OF SUCCESS - Reduction in empiric antibiotic usage in cases of COVID-19 where clinical suspicion for bacterial co-infection is low - Role of AMS team intervention in the reduction of unnecessary antibiotic usage FINDINGS TO DATE 61 patients were reviewed, all were started on antibiotics in emergency department which were continued beyond 24 hours. 41 (67.21%) met sepsis criteria on admission day;20 (32.78%) did not meet sepsis criteria;3 (4.91%) had suspected bacterial pulmonary co-infection based on clinical and imaging findings;1 had suspected aspiration pneumonia and 1 had culture-positive UTI. Most common antibiotics used were Ceftriaxone (n=61,100%), Doxycycline (n=44,72.13%), Azithromycin (n= 15,24.59%), Piperacillin/Tazobactam (n=4,6.56%) and Vancomycin (n=1,1.64%). Using EMR prompts and texts, days of unnecessary antibiotics saved were 46 days for 40 patients, presuming patients would have received at least 5 days of empiric antibiotics without AMS team intervention. Intervention on Day 2 of admission saved 32 days of unnecessary antibiotics for 18 patients and intervention after day 2, 14 days of antibiotics were saved for 22 patients. KEY LESSONS FOR DISSEMINATION The pandemic has amplified antibiotic prescriptions increasing concern for antibiotic resistance. AMS team can play a pivotal role as gatekeepers for the appropriate use of antimicrobials. In our analysis, no patients had adverse events related to early discontinuation of antibiotics during the same hospitalization, and only 4 (6.56%) patients had readmission related to secondary bacterial pulmonary infection. Despite being on antibiotics for 7 days, these patients developed secondary bacterial infection implying that antibiotics do not seem to be beneficial in preventing secondary infection. We observed maximum benefit when the AMS team intervened on Day 2 of admission which resulted in more days of unnecessary antibiotics saved. AMS team can be actively involved in developing guidelines, tracking toxicities, early de-escalation/discontinuation, and antibiotic “time outs” via EMR. We encourage a multidisciplinary approach to improve antibiotic stewardship in COVID-19.