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The Use of Antibiotics in COVID-19 Infections

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 27715

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Dr. Eleonora Nicolai

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Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
Interests: fluorescence; rapid AST (antibiotic susceptibility testing); microbiology diagnostic; FCS (fluorescence correlation spectroscopy); biophysics; fast bacteriuria screening
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Dear Colleagues,

A recent report on the casualties related to antibiotic resistance by the World Health Organization (WHO) identified an alarming rate of 700,000 lives per year at present and predicts a disturbing 10 million/year by 2050, ensuring that antibiotic resistance will be the most prevalent cause of death. Adding to this, the WHO also forewarns the severity of antibiotic resistance, stating that “it threatens the achievements of modern medicine, a post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century”.

Overuse or misuse of antibiotics recommended by physicians/self-medication at the time of infection have meant that drug-resistant pathogens become a major health care issue with millions of reported cases every year. With a pandemic such as COVID-19, the overuse of antibiotics can represent a critical point in fighting antimicrobial resistance. The unnecessary use of antibiotics can facilitate the spread of resistant pathogens, and the use of antibiotics in the management of a viral disease such as COVID-19 could have heavy implications for antimicrobial resistance response.

Therefore, this Special Issue aims to include studies on the use of antimicrobial therapy approaches in COVID-19 patients.

Dr. Eleonora Nicolai
Guest Editor

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Keywords

antibioitic susceptibility test
COVID-19 infection
antibiotic resistance
bacterial infection
microbiology diagnostic

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Published Papers (11 papers)

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17 pages, 923 KiB

Open AccessArticle

A Tale of Two Pandemics: Antimicrobial Resistance Patterns of Enterococcus spp. in COVID-19 Era

by Dan Alexandru Toc, Alexandru Botan, Ana Maria Cristia Botescu, Vlad Dumitru Brata, Ioana Alina Colosi, Carmen Costache and Lia Monica Junie

Antibiotics 2023, 12(2), 312; https://doi.org/10.3390/antibiotics12020312 - 2 Feb 2023

Cited by 2 | Viewed by 1640

Abstract

Although the COVID-19 pandemic has held the spotlight over the past years, the antimicrobial resistance (AMR) phenomenon continues to develop in an alarming manner. The lack of strict antibiotic regulation added to the overuse of antimicrobials fueled the AMR pandemic. This paper aims to analyze and identify the impact of the COVID-19 pandemic on antibiotic resistance patterns of Enterococcus spp. The study was designed as a retrospective observational study. Enterococcus spp. infections data were collected from one academic hospital in Cluj-Napoca, Romania over 18 months. A statistical analysis was performed to compare antibiotic resistance phenotypes identified. We recorded an increase in the isolation rates of Enterococcus spp. strains, from 26 isolates (26.53%) during Period A (November 2020–April 2021) to 42 strains (42.85%) during Period C (November 2021–April 2022). The number of strains with resistance to vancomycin increased from 8 during Period A to 17 during Period C. Of the total 36 strains with resistance to vancomycin, 25 were identified as E. faecium. SARS-CoV-2 patients (n = 29) proved to be at risk to develop an E. faecium co-infection (n = 18). We observed that strains with resistance to ampicillin (n = 20) and vancomycin (n = 15) are more often isolated from these patients. All changes identified in our study are to be considered in the light of COVID-19 pandemic, highlighting the threatening AMR phenomenon in Romania. Further studies should be performed to quantify the worldwide effects of these pandemics. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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14 pages, 537 KiB

Open AccessArticle

Assessing the Clinical Characteristics and Management of COVID-19 among Pediatric Patients in Ghana: Findings and Implications

by Israel Abebrese Sefah, Seth Adade Sarkodie, Giuseppe Pichierri, Natalie Schellack and Brian Godman

Antibiotics 2023, 12(2), 283; https://doi.org/10.3390/antibiotics12020283 - 1 Feb 2023

Cited by 4 | Viewed by 1741

Abstract

There is an increasing focus across countries on researching the management of children admitted to hospital with COVID-19. This stems from an increasing prevalence due to new variants, combined with concerns with the overuse of antimicrobials driving up resistance rates. Standard treatment guidelines (STGs) have been produced in Ghana to improve their care. Consequently, there is a need to document the clinical characteristics of children diagnosed and admitted with COVID-19 to our hospital in Ghana, factors influencing compliance to the STG and treatment outcomes. In all, 201 patients were surveyed between March 2020 and December 2021, with males accounting for 51.7% of surveyed children. Those aged between 6 and 10 years were the largest group (44.8%). Nasal congestion and fever were some of the commonest presenting complaints, while pneumonia was the commonest (80.6%) COVID-19 complication. In all, 80.0% of all admissions were discharged with no untreated complications, with a 10.9% mortality rate. A combination of azithromycin and hydroxychloroquine (41.29%) was the most prescribed antimicrobial regimen. Compliance to the STG was variable (68.2% compliance). Increased compliance was associated with a sore throat as a presenting symptom. Mortality increased following transfer to the ICU. However, current recommendations to prescribe antimicrobials without demonstrable bacterial or fungal infections needs changing to reduce future resistance. These are areas to address in the future. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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10 pages, 278 KiB

Open AccessArticle

Use of Systemic Antibiotics in Patients with COVID-19 in Colombia: A Cross-Sectional Study

by Luis Fernando Valladales-Restrepo, Ana Camila Delgado-Araujo, Luisa Fernanda Echeverri-Martínez, Verónica Sánchez-Ríos and Jorge Enrique Machado-Alba

Antibiotics 2023, 12(2), 252; https://doi.org/10.3390/antibiotics12020252 - 26 Jan 2023

Viewed by 1703

Abstract

Antibiotics are frequently prescribed to patients with COVID-19. The aim was to determine the pattern of use of systemic antibiotics in a group of patients diagnosed with COVID-19 in Colombia between 2020–2022. This was a descriptive cross-sectional study designed to identify antibiotics prescription patterns for patients diagnosed with COVID-19 treated in eight clinics in Colombia. The AWaRe tool of the World Health Organization (WHO) was used to classify the antibiotics. A total of 10,916 patients were included. The median age was 57 years, and 56.4% were male. A total of 57.5% received antibiotics, especially ampicillin/sulbactam (58.8%) and clarithromycin (47.9%). Most of the antibiotics were classified as Watch (65.1%), followed by Access (32.6%) and Reserve (2.4%). Men (OR: 1.29; 95%CI: 1.17–1.43), older adults (OR: 1.67; 95%CI: 1.48–1.88), patients with dyspnea (OR: 1.26; 95%CI: 1.13–1.41), rheumatoid arthritis (OR: 1.94; 95%CI: 1.17–3.20), and high blood pressure at admission (OR: 1.45; 95%CI: 1.29–1.63), patients treated in-hospital (OR: 5.15; 95%CI: 4.59–5.77), patients admitted to the ICU (OR: 10.48; 95%CI: 8.82–12.45), patients treated with systemic glucocorticoids (OR: 3.60; 95%CI: 3.21–4.03) and vasopressors (OR: 2.10; 95%CI: 1.60–2.75), and patients who received invasive mechanical ventilation (OR: 2.37; 95%CI: 1.82–3.09) were more likely to receive a systemic antibiotic. Most of the patients diagnosed with COVID-19 received antibiotics, despite evidence showing that bacterial coinfection is rare. Antibiotics from the Watch group predominated, a practice that goes against WHO recommendations. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

13 pages, 1637 KiB

Open AccessArticle

Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series

by Davide Fiore Bavaro, Alessandra Belati, Lucia Diella, Melita Anna Poli, Angela Calamo, Giovanna De Candia, Maurantonio Altamura, Felicia Anna Spadavecchia, Gaetano Brindicci, Nicolò De Gennaro, Francesco Di Gennaro, Annalisa Saracino and Sergio Carbonara

Antibiotics 2022, 11(11), 1519; https://doi.org/10.3390/antibiotics11111519 - 31 Oct 2022

Cited by 3 | Viewed by 1635

Abstract

Secondary bloodstream infections (BSIs) caused by KPC- and NDM-producing Klebsiella pneumoniae (K.p.) during the course of COVID-19 infections lead to significant mortality. Herein, a comparative retrospective case series of KPC- or NDM-K.p. BSIs occurring in COVID-19 subjects treated with Ceftazidime/Avibactam (CAZ/AVI) for KPC-K.p., or CAZ/AVI+ Aztreonam (ATM) for NDM-K.p is reported. All patients hospitalized for COVID-19 in two Italian hospitals with a BSI between March and September 2021 were included. The main outcome was 14-day mortality. Overall, 44 patients were included: 23 with KPC-K.p. and 21 with NDM-K.p. BSIs. The median (q1–q3) age was 67 (57–75) years, and 32 (72%) were males. The two groups were similar in terms of baseline comorbidity, or severity of COVID-19. Notably, 14-day mortality of KPC-K.p. BSIs and NDM-K.p. BSIs (26% vs. 38%, p = 0.521) and 28-day mortality (35% vs. 48%, p = 0.541) were similar. A Cox regression model of delayed initiation of an appropriate antibiotic therapy after the onset of symptoms independently predicted mortality: initiation between 24 and 72 h (aHR = 12.03; 95% CI = 1.10–130, p = 0.041); and initiation after 72h (aHR = 36.9, 95% CI = 3.22–424, p = 0.004). Moreover, a trend towards an increased risk of mortality was observed for polymicrobial infections (aHR = 3.73, 95% CI = 0.87–15.8, p = 0.074), while a protective effect was observed for a beta-lactam loading dose at the start of treatment (aHR = 0.16, 95% CI = 0.02–1.10, p = 0.064). The high mortality of KPC and NDM-K.p. BSIs in COVID-19 patients may be reduced by an early and appropriate antibiotic therapy. Further efforts should be made to develop antimicrobial stewardship and infection control programs in COVID-19 wards. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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11 pages, 969 KiB

Open AccessArticle

Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

by Shena Y. C. Lim, Yvonne P. Zhou, Daphne Yii, De Zhi Chin, Kai Chee Hung, Lai Wei Lee, Jia Le Lim, Li Wen Loo, Narendran Koomanan, Nathalie Grace Chua, Yixin Liew, Benjamin P. Z. Cherng, Siew Yee Thien, Winnie H. L. Lee, Andrea L. H. Kwa and Shimin J. Chung

Antibiotics 2022, 11(7), 846; https://doi.org/10.3390/antibiotics11070846 - 24 Jun 2022

Cited by 2 | Viewed by 2397

Abstract

At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify “high yield” interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6–8) vs. 6 (3–8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to “complete the course” (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber’s practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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11 pages, 503 KiB

Open AccessArticle

Real-World Effectiveness and Optimal Dosage of Favipiravir for Treatment of COVID-19: Results from a Multicenter Observational Study in Thailand

by Pinyo Rattanaumpawan, Supunnee Jirajariyavej, Kanokorn Lerdlamyong, Nattawan Palavutitotai and Jatuporn Saiyarin

Antibiotics 2022, 11(6), 805; https://doi.org/10.3390/antibiotics11060805 - 15 Jun 2022

Cited by 19 | Viewed by 2899

Abstract

Favipiravir is a broad-spectrum oral antiviral agent that shows in vitro activity against SARS-CoV-2. Presently, data on the real-world effectiveness and optimal dosage of favipiravir for treating COVID-19 are limited. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these 63 patients, 61.9% were male with a median age of 48 years (range 22–85 years), 27.0% required an O₂ nasal cannula, 9.5% required non-invasive ventilation and/or high-flow O₂ therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5 (0–16). The Day-7 clinical improvement rate [95%CI] was 66.7% [53.7–78.0%] in all patients, 92.5% [75.7–99.1%] in patients who did not require O₂ supplementation, and 47.2% [0.4–64.5%] in patients who required O₂ supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. A multivariate analysis revealed three poor prognostic factors for Day-7 clinical improvement (odds ratio (95%CI); p-value): older age (0.94 (0.89–0.99); p = 0.04), a higher baseline NEWS2 score (0.64 (0.47–0.88); p = 0.006), and a lower favipiravir loading dose (≤45 mg/kg/day) (0.04 (0.005–0.4); p = 0.006). In conclusion, our study reports the promising effectiveness of favipiravir for treating COVID-19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≤45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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7 pages, 469 KiB

Open AccessArticle

Empirical Antibiotic Prescribing in Adult COVID-19 Inpatients over Two Years in Mexico

by Efrén Murillo-Zamora, Xóchitl Trujillo, Miguel Huerta, Oliver Mendoza-Cano, José Guzmán-Esquivel, José Alejandro Guzmán-Solórzano, María Regina Ochoa-Castro, Alan Gabriel Ortega-Macías, Andrea Lizeth Zepeda-Anaya, Valeria Ruiz-Montes de Oca, Mónica Ríos-Silva and Agustin Lugo-Radillo

Antibiotics 2022, 11(6), 764; https://doi.org/10.3390/antibiotics11060764 - 2 Jun 2022

Cited by 6 | Viewed by 2209

Abstract

Background and Objectives: Empirical antibiotic prescribing in patients with coronavirus disease 2019 (COVID-19) has been common even though bacterial coinfections are infrequent. The overuse of antibacterial agents may accelerate the antibiotic resistance crisis. We aimed to evaluate factors predicting empirical antibiotic prescribing to adult COVID-19 inpatients over 2 years (March 2020–February 2021) in Mexico. Materials and Methods: A cross-sectional analysis of a nationwide cohort study was conducted. Hospitalized adults due to laboratory-confirmed COVID-19 were included (n = 214,171). Odds ratios (OR) and 95% confidence intervals (CI), computed by using logistic regression models, were used to evaluate factors predicting empirical antibiotic prescribing. Results: The overall frequency of antibiotic usage was 25.3%. In multiple analysis, the highest risk of antibiotic prescription was documented among patients with pneumonia at hospital admission (OR = 2.20, 95% CI 2.16–2.25). Male patients, those with chronic comorbidities (namely obesity and chronic kidney disease) and longer interval days from symptoms onset to healthcare seeking, were also more likely to receive these drugs. We also documented that, per each elapsed week during the study period, the odds of receiving antibiotic therapy decreased by about 2% (OR = 0.98, 95% CI 0.97–0.99). Conclusion: Our study identified COVID-19 populations at increased risk of receiving empirical antibiotic therapy during the first two years of the pandemic. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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8 pages, 908 KiB

Open AccessArticle

Real-World Use of Sotrovimab for Pre-Emptive Treatment in High-Risk Hospitalized COVID-19 Patients: An Observational Cross-Sectional Study

by Sean W. X. Ong, Dongdong Ren, Pei Hua Lee, Stephanie Sutjipto, Christopher Dugan, Bo Yan Khoo, Jun Xin Tay, Shawn Vasoo, Barnaby E. Young and David C. Lye

Antibiotics 2022, 11(3), 345; https://doi.org/10.3390/antibiotics11030345 - 5 Mar 2022

Cited by 15 | Viewed by 3643

Abstract

Data on use of monoclonal antibodies (mAbs) in hospitalized patients are limited. In this cross-sectional study, we evaluated the use of mAbs for early treatment of unvaccinated hospitalized patients with mild-to-moderate COVID-19. All inpatients at our center were screened on 27 October 2021. Primary outcome was in-hospital deterioration as defined by a composite of oxygen requirement, intensive care unit (ICU) admission, or mortality within 28 days of admission. Ninety-four out of 410 COVID-19 inpatients were included in the final analysis, of whom 19 (20.2%) received early treatment with sotrovimab. The median age was 73 years (IQR 61–83), and 35 (37.2%) were female. Although the treatment group was significantly older and had more comorbidities, there was a lower proportion of progression to oxygen requirement (31.6% vs. 54.7%), ICU admission (10.5% vs. 24.0%), or mortality (5.3% vs. 13.3%). Kaplan–Meier curves showed a significant difference in time to in-hospital deterioration (log-rank test, p = 0.043). Cox proportional hazards model for in-hospital deterioration showed that sotrovimab treatment was protective (hazard ratio, 0.41; 95% CI, 0.17–0.99; p = 0.047) after adjustment for baseline ISARIC deterioration score. Our findings support the use of sotrovimab for early treatment in hospitalized patients with mild-to-moderate COVID-19 at a high risk of disease progression. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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11 pages, 457 KiB

Open AccessArticle

Prescription Patterns of Drugs Given to Hospitalized COVID-19 Patients: A Cross-Sectional Study in Colombia

by Luis Fernando Valladales-Restrepo, Jaime Andrés Giraldo-Correa, Brayan Stiven Aristizábal-Carmona, Camilo Alexander Constain-Mosquera, Alejandra Sabogal-Ortiz and Jorge Enrique Machado-Alba

Antibiotics 2022, 11(3), 333; https://doi.org/10.3390/antibiotics11030333 - 3 Mar 2022

Cited by 5 | Viewed by 3133

Abstract

The impact of COVID-19 prompted a race to find a treatment that would reduce its mortality. Most studies have not shown favorable results for many of these drugs, but they are still used. The aim as to determine the differences and similarities in the hospital pharmacological management of patients with COVID-19 according to sex, age group, and geographical region of Colombia, 2020–2021. Descriptive cross-sectional study was conducted on the prescription patterns of the medications given to patients diagnosed with COVID-19 treated in eight clinics in Colombia between 6 March 2020 and 31 May 2021. We performed a descriptive analysis of the sociodemographic, clinical, and pharmacological variables of the patients. A total of 8596 patients from 170 cities were identified, with a median age of 53.0 years and 53.3% of them men. A total of 24.3% required care in the intensive care unit, and 18.7% required invasive mechanical ventilation. The most commonly used drugs for the treatment of COVID-19 were systemic corticosteroids (63.6%), followed by colchicine (12.8%), azithromycin (8.9%), and ivermectin (6.4%). Corticosteroids, anticoagulants, colchicine, azithromycin, ivermectin, and hydroxychloroquine were prescribed more frequently in men, and their overall use increased with age. There were differences in prescriptions between geographic regions. The majority of patients were managed with medications included in the management guidelines. There were differences between sexes, age groups, and geographical regions. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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Review

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10 pages, 371 KiB

Open AccessReview

Self-Medication with Antibiotics during COVID-19 in the Eastern Mediterranean Region Countries: A Review

by Feras Jirjees, Munazza Ahmed, Somayeh Sayyar, Monireh Amini, Hala Al-Obaidi and Mamoon A. Aldeyab

Antibiotics 2022, 11(6), 733; https://doi.org/10.3390/antibiotics11060733 - 30 May 2022

Cited by 18 | Viewed by 3454

Abstract

Self-treatment with medicines including treatment with antibiotics is a growing global concern, as it can cause public health problems, such as antibiotic resistance and drug toxicity. Therefore, the significance of the self-medication impact of COVID-19 in any region can have an influence on the prevalence of such problems. The review aimed to investigate the self-treatment with antibiotics among the general population in Eastern Mediterranean region countries during COVID-19 pandemic. A comprehensive review of literature in four databases was conducted for the pandemic period from January 2020 to the end of March 2022. Nine studies related to self-treatment with antibiotics were found. The studies were homogeneous in terms of assessing the antibiotic self-treatment usage during the COVID-19 pandemic among the general population and among community pharmacies. The prevalence of self-treatment with antibiotics ranged from 20.8% to 45.8% between the studies. The main reasons for that were cost-saving, fear of COVID-19 infection, quarantine, and ease of accessibility without time limits. Antibiotic self-treatment has been high during the COVID-19 pandemic; however, it was less reported during the study period than before the time of the pandemic. There is a need for more restrictions on dispensing antibiotics from community pharmacies. In addition, there is a need to raise awareness among the population regarding self-treatment with antibiotics. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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Other

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8 pages, 742 KiB

Open AccessBrief Report

Antibiotic (Mis)Use in COVID-19 Patients before and after Admission to a Tertiary Hospital in Serbia

by Aleksa Despotović, Aleksandra Barać, Teodora Cucanić, Ksenija Cucanić and Goran Stevanović

Antibiotics 2022, 11(7), 847; https://doi.org/10.3390/antibiotics11070847 - 24 Jun 2022

Cited by 13 | Viewed by 1897

Abstract

Antimicrobial resistance (AMR) is a global concern, and antibiotic use has risen throughout the COVID-19 pandemic. Up to 75% of COVID-19 patients are treated with antibiotics despite little evidence for their use. A retrospective study from 6 March 2020 (the start of the pandemic in Serbia) to 31 December 2021 was conducted at the Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia. In total, 523 patients with a microbiological diagnosis of COVID-19 were included. Patient data were analysed, including antibiotic use before and after admission. Pre-admission use of antibiotics for COVID-19 treatment was documented in more than half of patients (58.1%), of which a third (34.1%) used more than one antibiotic. Macrolides, cephalosporins, and fluoroquinolones were mainly used, most frequently among patients aged between 31–45 years (75.2%). Prior antibiotic use was associated with a longer duration of illness at admission (8.8 vs. 5.7, p < 0.001), oxygen therapy upon admission (27.6% vs. 16.0%, p = 0.002), and a lower vaccination rate (60.7% vs. 50.7%, p = 0.04). When hospitalised, 72.1% of patients received antibiotics, primarily cephalosporins (71.9%). Significant efforts are needed to reduce antibiotic use in the community and improve prescribing rates by healthcare professionals. Full article

(This article belongs to the Special Issue The Use of Antibiotics in COVID-19 Infections)

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