Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals. Issue 6 (December 2020)

• Record Type: Journal Article
• Authors: Seaton, Ronald A.; Gibbons, Cheryl L.; Cooper, Lesley; Malcolm, William; McKinney, Rachel; Dundas, Stephanie; Griffith, David; Jeffreys, Danielle; Hamilton, Kayleigh; Choo-Kang, Brian; Brittain, Suzanne; Guthrie, Debbie; Sneddon, Jacqueline
• Is Part Of: Journal of infection. Volume 81:Issue 6(2020)
• Page Start: 952
• Page End: 960
• Publication Date: 2020-12
• Subjects: SARS-CoV-2 -- Antimicrobial stewardship -- Antibiotic stewardship -- Scottish antimicrobial prescribing group -- Nosocomial infection -- Bacterial co-infection -- Coronavirus -- Nosocomial fungal infection; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2020.09.024
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Antibiotic prevalence survey of 2/5 hospitalised SARS-CoV-2 patients at the epidemic peak in Scotland. Antibiotics in 38% SARS-CoV-2 patients in wards and critical care units. Narrow spectrum antibiotics predominant in wards reflecting national recommendations. Broad spectrum antibiotics and antifungals in critical care indicative of suspected nosocomial bacterial and fungal infections. Lower odds of antibiotic associated with nosocomial COVID-19, diabetes and in elderly care. Summary: Background: Concern regarding bacterial co-infection complicating SARS-CoV-2 has created a challenge for antimicrobial stewardship. Following introduction of national antibiotic recommendations for suspected bacterial respiratory tract infection complicating COVID-19, a point prevalence survey of prescribing was conducted across acute hospitals in Scotland. Methods: Patients in designated COVID-19 units were included and demographic, clinical and antimicrobial data were collected from 15 hospitals on a single day between 20th and 30th April 2020. Comparisons were made between SARS-CoV-2 positive and negative patients and patients on non-critical care and critical care units. Factors associated with antibiotic prescribing in SARS-CoV-2 positive patients were examined using Univariable and multivariable regression analyses. Findings: There were 820 patients were included, 64.8% were SARS-CoV-2 positive and 14.9% were managed in critical care, and 22.1% of SARS-CoV-2 infections were considered probable or definite nosocomial infections. On the survey day, antibiotic prevalence was 45.0% and 73.9% were prescribed for suspected respiratory tract infection. Amoxicillin, doxycycline and co-amoxiclav accounted for over half of all antibiotics in non-critical care wards and meropenem, piperacillin-tazobactam and co-amoxiclav accounted for approximately half prescribed in critical care. Of all SARS-CoV-2 patients, 38.3% were prescribed antibiotics. In a multivariable logistic regression analysis, COPD/chronic lung disease and CRP ≥ 100 mg/l were associated with higher odds and probable or confirmed nosocomial COVID-19, diabetes and management on an elderly care ward had lower odds of an antibiotic prescription. Systemic antifungals were prescribed in 9.8% of critical care patients and commenced a median of 18 days after critical care admission. Interpretation: A relatively low prevalence of antibiotic prescribing in SARS-CoV-2 hospitalised patients and low proportion of broad spectrum antibiotics in non-critical care settings was observed potentially reflecting national antimicrobial stewardship initiatives. Broad spectrum antibiotic and antifungal prescribing in critical care units was observed indicating the importance of infection prevention and control and stewardship initiatives in this setting. Funding: The Scottish Antibiotic Prescribing Group is funded by Scottish Government.