Antibiotic Use in Patients With COVID-19

Antimicrobial resistance is a serious threat to public health. The ongoing antimicrobial resistance pandemic has been fueled by the COVID-19 pandemic. We analyzed patients 15 years or older with COVID-19 who were admitted to a teaching hospital in Mashhad, Iran, during the period between the third and fourth COVID-19 waves. COVID-19 was diagnosed if the SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction test was positive in patients with compatible clinical syndromes. Overall, 532 episodes of COVID-19 were diagnosed. The median age of patients was 61 years (interquartile range, 48–73). One hundred twenty-five patients (23.4%) with COVID-19 died, and 165 (31%) experienced major complications. Over the study period, 134 DDD (defined daily dose) per 100 hospital bed days of antibacterial were used. Glycopeptides, third-generation cephalosporins, and carbapenems were the antibacterials most frequently used, based on the DDD per 100 hospital bed days. In a multivariate analysis, factors associated with antibacterial prescription in COVID-19 patients were lung involvement of greater than 50% (odds ratio [OR], 14.6), C-reactive protein of greater than 100 mg/L (OR, 3.35), and hypoxia (OR, 3.06). Univariate but not multivariate analysis showed that antibiotic use in COVID-19 patients was associated with 4 times increase in the chance of death (OR, 4.23). Our study highlights a high rate of antibacterial use in COVID-19 patients. Hypoxia, C-reactive protein of greater than 100 mg/L, and severe lung involvement were associated with a higher rate of antibacterial prescription. The patients who received antibiotics died 4.23 times more often than patients treated without antibiotics. These findings emphasize the need for integrating antimicrobial stewardship programs as an integral part of the pandemic response and the need for improving diagnostic tests for early detection of bacterial coinfections in COVID-19 patients.