Early Empiric Antibiotic Use in Patients Hospitalized with Covid-19: A Retrospective Cohort Study

ABSTRACT

INTRODUCTION: The appropriate use of empiric antibiotics is a clinical challenge for patients with severe COVID-19. Early in the pandemic, there was concern that bacterial coinfection would influence morbidity and mortality. This concern often led to treating patients empirically with antibiotics. Fortunately, early data from the COVID-19 pandemic suggests bacterial coinfection is uncommon. However, there has been little published data on the antibiotic prescribing practices over the course of the pandemic. This study aims to investigate the inter-center variation and temporal trends of early antibiotic prescribing in patients hospitalized with COVID-19. METHOD(S) We performed a retrospective analysis using the National COVID Cohort Collaborative database. We identified patients admitted between March 2020 and December 2021 who had a positive COVID-19 PCR or antigen test 15 days prior or within 48 hours of admission. Age at time of COVID-19 diagnosis, gender, race/ethnicity, Charlson comorbidity index, the month of hospitalization, antibiotics received, labs at the time of hospital admission, and center identifier were collected. A chi-square test was used for categorical data and Wilcoxon rank-sum test for continuous data. Mixed effects logistic regression was used to evaluate predictors of early empiric antibiotic use. RESULT(S) Of 280,601 qualifying first hospitalizations, 30,469 patients received early empiric antibiotics. Antibiotic use declined across all centers over time from the first month (23%) to the last month in (8.1%) in the data collection period (p < 0.01). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (OR 2.25, 95% CI 2.14 - 2.36) and ECMO before day 2 (OR 1.60, 95% CI 1.25 - 2.05) but not region of residence was associated with early empiric antibiotic use. CONCLUSION(S) Although treatment of COVID-19 patients with empiric intravenous antibiotics has declined during the pandemic, the frequency of use remains higher than the reported incidence of bacterial superinfection. There is significant inter-center variation in antibiotic prescribing practices. Future research should focus on comparing outcomes and adverse events among COVID-19 patients treated with and without empiric antibiotics.