Patients hospitalized with COVID-19 were unlikely to develop concurrent infectious disease or benefit from antibiotics, in the Evaluation of a hospital that limits antibiotics from its COVID-19 treatment protocols in the absence of symptoms suggestive of another infection.
Reviewing the literature before conducting their own study, Junpei Komagamine, MD and colleagues at Tochigi Medical Center, Tochigi, Japan, found that approximately 70% of patients hospitalized with COVID-19 receive antibiotics. They postulated that the restrictions on antibiotics in their hospital provided an opportunity to examine the extent to which antibiotics are needed.
“Data are needed on patients infected with COVID-19 who do not routinely receive a prescription for antimicrobial drugs, to identify the true rate of concurrent infection in this patient population,” Komagamine and colleagues explained.
Investigators retrospectively reviewed the records of 1056 patients hospitalized with laboratory-confirmed COVID-19 infection during the period from November 1, 2020 to October 9, 2921. Their median age was 50 years (36-61); 669 were men (63.4%). Symptoms of COVID-19 were classified according to WHO guidelines as mild in 50.9%, moderate in 29.6% and severe in 19.2%. The onset of symptoms was on average 5 days (3-7) before admission.
Most (91.7%) had not been vaccinated against COVID-19. Underlying medical conditions included diabetes in 11.7% and congestive lung disease or asthma in 7.9%. Fever was present on admission in 60.9% and pneumonia developed in 48.7%. The median length of hospitalization was 6 days (4-8). During hospitalization, 9 patients (0.9%) died.
Although 104 patients (9.9%) were prescribed antibiotics before admission, only 18 (1.5%) received them during hospitalization. Of the 18 patients, 15 were prescribed the antibiotic as active treatment, and 3 as prophylaxis. Microbiologically confirmed infectious diseases other than COVID-19 were detected in only 6 patients during their hospitalization.
“The results revealed that concurrent infectious diseases occurred rarely despite infrequent use of antimicrobial drugs during hospitalization in patients with COVID-19,” Komagamine and colleagues reported.
“Since most non-critical patients have recovered without antimicrobial drugs, the use of most antimicrobial drugs to treat non-critical cases in many hospitals may be unnecessary,” they suggest. .
The investigators acknowledge that the retrospective data collection, single-center design, and short-term follow-up might limit the applicability of their findings to other sites. Additionally, they note that they had excluded patients (47) who were transferred to other hospitals. for intensive care; and that the study population included few (1.4%) immunocompromised patients. They also note that a positive microbial test does not necessarily indicate a true infection.
They attribute the study’s strengths and importance to adherence to the Enhanced Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines and to the evaluation of all antimicrobial drugs, regardless of the reason for their use ; and finding an extremely low utilization rate compared to previous studies.