The Effect of Antibiotic Use on Intensive Care Unit Admission and Mortality in Inpatients with COVID-19 Diagnosis

Abstract

Aim: The coronavirus disease 2019 (COVID-19) pandemic had and continues to directly impact antibiotic management. This study aimed to evaluate antibiotic use and its impact on intensive care unit (ICU) admission and mortality in COVID-19 patients. Material and Methods: The medical records of 324 COVID-19 patients aged ≥18 years who had clinical signs of infection and were followed up in the service were retrospectively evaluated. Patients were divided into two groups, those who received antibiotics and those who did not. Patients transferred from the ICU to the ward, discharged on the first day, or had missing data were excluded from the study. Results: Of the patients, 172 (53.1%) were male, 152 (46.9%) were female, and 212 (65.4%) received antibiotic treatment. Hospitalization longer than one week (p<0.001), pulse steroid use (p=0.011), ICU admission (p=0.002) and mortality (p<0.001) were significantly higher in patients receiving antibiotics. While CRP (p<0.001), PCT (p=0.001), and ferritin (p=0.017) values obtained at admission and 48-72 hours were also found to be higher in antibiotic-using patients, there was no difference in CRP value (p=0.052) at discharge. Duration of hospitalization, antibiotic use, pulse steroid use, and being 60 years and older were found to be risk factors for mortality and ICU admission. Conclusion: Overusing antibiotics in COVID-19 patients did not have a positive effect on mortality and ICU requirements. Considering the harms of excessive antibiotic use, recommendations and practices that lead to rational antibiotic use are needed. Furthermore, factors predicting mortality and ICU can be used in clinical practice.

Keywords

• antibiotic
• COVID-19
• intensive care unit
• mortality

COVID-19 Tanısıyla Yatan Hastalarda Antibiyotik Kullanımının Yoğun Bakım Ünitesine Yatış ve Mortalite Üzerine Etkisi

Abstract

Amaç: Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) pandemisinin antibiyotik yönetimi üzerinde doğrudan bir etkisi olmuştur ve olmaya devam etmektedir. Bu çalışmanın amacı, COVID-19 hastalarında antibiyotik kullanımı ve bunun yoğun bakım ünitesine (YBÜ) yatış ve mortalite üzerindeki etkisini değerlendirmektir. Gereç ve Yöntemler: Enfeksiyonun klinik bulguları olan ve serviste takip edilen ≥18 yaş 324 COVID-19 hastasının tıbbi kayıtları geriye dönük olarak değerlendirildi. Hastalar antibiyotik tedavisi alanlar ve almayan olmak üzere iki ayrı gruba ayrıldı. YBÜ'den servise devredilen, birinci gün taburcu edilen veya eksik verisi olan hastalar çalışma dışı bırakıldı. Bulgular: Hastaların 172’si (%53,1) erkek, 152’si (%46,9) kadın ve 212’si (%65,4) antibiyotik tedavisi almıştı. Bir haftadan uzun hastanede yatış (p<0,001), pulse steroid kullanımı (p=0,011), yoğun bakım yatışı (p=0,002) ve mortalite (p<0,001) antibiyotik kullanan hastalarda anlamlı olarak daha yüksekti. Antibiyotik kullanan hastalarda yatışta ve 48-72. saatlerde elde edilen CRP (p<0,001), PCT (p=0,001) ve ferritin (p=0,017) değerleri de daha yüksek bulunurken, taburculuktaki CRP değeri (p=0,052) açısından fark yoktu. Hastanede yatış süresi, antibiyotik kullanımı, pulse steroid kullanımı ve 60 yaş ve üzeri olmak mortalite ve YBÜ yatış için risk faktörleri olarak bulunmuştur. Sonuç: COVID-19 hastalarında aşırı antibiyotik kullanımının, mortalite ve YBÜ gereksinimi üzerinde olumlu bir etkisi olmamıştır. Aşırı antibiyotik kullanımının zararları göz önüne alınarak akılcı antibiyotik kullanımına yönlendiren öneri ve uygulamalara ihtiyaç vardır. Bununla birlikte mortalite ve YBÜ yatışı yordayan faktörlerin klinik pratikte kullanımı fayda sağlayabilir.

Keywords

• antibiyotik
• COVID-19
• yoğun bakım ünitesi
• mortalite

References

1. Bartoletti M, Azap O, Barac A, Bussini L, Ergonul O, Krause R, et al. ESCMID COVID-19 living guidelines: drug treatment and clinical management. Clin Microbiol Infect. 2022;28(2):222-38.
2. Mahida N, Winzor G, Wilkinson M, Jumaa P, Gray J. Antimicrobial stewardship in the post COVID-19 pandemic era: an opportunity for renewed focus on controlling the threat of antimicrobial resistance. J Hosp Infect. 2022;129:121-3.
3. Calderón-Parra J, Muiño-Miguez A, Bendala-Estrada AD, Ramos-Martínez A, Muñez-Rubio E, Fernández Carracedo E, et al. Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID. PLoS One. 2021;16(5):e0251340.
4. Murray AK. The novel coronavirus COVID-19 outbreak: Global implications for antimicrobial resistance. Front Microbiol. 2020;11:1020.
5. Langford BJ, So M, Raybardhan S, Leung V, Soucy JR, Westwood D, et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021;27(4):520-31.
6. Martin AJ, Shulder S, Dobrzynski D, Quartuccio K, Pillinger KE. Antibiotic use and associated risk factors for antibiotic prescribing in COVID-19 hospitalized patients. J Pharm Pract. 2023;36(2):256-63.
7. Carbonell R, Urgelés S, Salgado M, Rodríguez A, Reyes LF, Fuentes YV, et al. Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical COVID-19 patients. J Infect. 2022;85(4):374-81.
8. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.

9. Chaaban T, Ezzeddine Z, Ghssein G. Antibiotic misuse during the COVID-19 pandemic in Lebanon: a cross-sectional study. COVID. 2024;4(7):921-9.
10. Şencan İ, Çağ Y, Karabay O, Kurtaran B, Güçlü E, Öğütlü A, et al. Antibiotic use and influencing factors among hospitalized patients with COVID-19: a multicenter point-prevalence study from Turkey. Balkan Med J. 2022;39(3):209-17.
11. Popp M, Stegemann M, Riemer M, Metzendorf MI, Romero CS, Mikolajewska A, et al. Antibiotics for the treatment of COVID-19. Cochrane Database Syst Rev. 2021;10(10):CD015025.
12. Westblade LF, Simon MS, Satlin MJ. Bacterial coinfections in coronavirus disease 2019. Trends Microbiol. 2021;29(10):930-41.
13. Ukuhor HO. The interrelationships between antimicrobial resistance, COVID-19, past, and future pandemics. J Infect Public Health. 2021;14(1):53-60.
14. Ghosh S, Bornman C, Zafer MM. Antimicrobial resistance threats in the emerging COVID-19 pandemic: Where do we stand? J Infect Public Health. 2021;14(5):555-60.
15. Haqqi A, Awan UA, Ahmed H, Afzal MS. Antimicrobial resistance vs COVID-19: A bigger challenge in the post-pandemic era! J Formos Med Assoc. 2021;120(7):1537-8.
16. Ma ESK, Kung KH, Chen H. Combating antimicrobial resistance during the COVID-19 pandemic. Hong Kong Med J. 2021;27(6):396-8.
17. Rickard J, Boulware DR, Guan W, Ntirenganya F, Kline S. Has there been exacerbation of disparities in antimicrobial resistance during the SARS-CoV-2 pandemic? Surg Infect (Larchmt). 2022;23(7):613-5.
18. Rosca A, Balcaen T, Lanoix JP, Michaud A, Moyet J, Marcq I, et al. Mortality risk and antibiotic use for COVID-19 in hospitalized patients over 80. Biomed Pharmacother. 2022;146:112481.
19. Wu HY, Chang PH, Chen KY, Lin IF, Hsih WH, Tsai WL, et al. Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: Incidence, diagnosis and treatment. J Microbiol Immunol Infect. 2022;55(6 Pt 1):985-92.
20. Galli F, Bindo F, Motos A, Fernández-Barat L, Barbeta E, Gabarrús A, et al. Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients. Intensive Care Med. 2023;49(8):934-45.
21. Wolfisberg S, Gregoriano C, Schuetz P. Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19. Crit Rev Clin Lab Sci. 2022;59(1):54-65.
22. Roy A, Powers HR, Craver EC, Nazareno MD, Yarrarapu SNS, Sanghavi DK. Antibiotic stewardship: Early discontinuation of antibiotics based on procalcitonin level in COVID-19 pneumonia. J Clin Pharm Ther. 2022;47(2):243-7.
23. Covington EW, Roberts MZ, Dong J. Procalcitonin monitoring as a guide for antimicrobial therapy: A review of current literature. Pharmacotherapy. 2018;38(5):569-81.
24. Lee CC, Chang JC, Mao XW, Hsu WT, Chen SY, Chen YC, et al. Combining Procalcitonin and rapid multiplex respiratory virus testing for antibiotic stewardship in older adult patients with severe acute respiratory infection. J Am Med Dir Assoc. 2020;21(1):62-7.
25. Smith SE, Muir J, Kalabalik-Hoganson J. Procalcitonin in special patient populations: Guidance for antimicrobial therapy. Am J Health Syst Pharm. 2020;77(10):745-58.
26. Hessels LM, Speksnijder E, Paternotte N, van Huisstede A, Thijs W, Scheer M, et al. Procalcitonin-guided antibiotic prescription in patients with COVID-19: a multicenter observational cohort study. Chest. 2023;164(3):596-605.
27. Ming DK, Myall AC, Hernandez B, Weiße AY, Peach RL, Barahona M, et al. Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin. BMC Infect Dis. 2021;21(1):932. Erratum in: BMC Infect Dis. 2021;21(1):988.