Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis
The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. We searched MEDLIN...
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| Published in | Clinical microbiology and infection Vol. 27; no. 4; pp. 520 - 531 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.04.2021
Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases |
| Subjects | |
| Online Access | Get full text |
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| Abstract | The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.
The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.
We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.
We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.
The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult).
The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis.
We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies.
Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19. |
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| AbstractList | The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.BACKGROUNDThe proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.OBJECTIVEThe aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.DATA SOURCESWe searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.STUDY ELIGIBILITY CRITERIAWe included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult).PARTICIPANTSThe study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult).The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis.METHODSThe main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis.We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3-80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03-0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18-1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15-1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7-15.2%) from 31 studies.RESULTSWe screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3-80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03-0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18-1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15-1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7-15.2%) from 31 studies.Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.CONCLUSIONSThree-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19. The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19. |
| Author | Leung, Valerie Langford, Bradley J. Raybardhan, Sumit Daneman, Nick So, Miranda MacFadden, Derek R. Soucy, Jean-Paul R. Westwood, Duncan |
| Author_xml | – sequence: 1 givenname: Bradley J. surname: Langford fullname: Langford, Bradley J. email: brad.langford@gmail.com organization: Public Health Ontario, ON, Canada – sequence: 2 givenname: Miranda surname: So fullname: So, Miranda organization: Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Canada – sequence: 3 givenname: Sumit surname: Raybardhan fullname: Raybardhan, Sumit organization: North York General Hospital, ON, Canada – sequence: 4 givenname: Valerie surname: Leung fullname: Leung, Valerie organization: Public Health Ontario, ON, Canada – sequence: 5 givenname: Jean-Paul R. surname: Soucy fullname: Soucy, Jean-Paul R. organization: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada – sequence: 6 givenname: Duncan surname: Westwood fullname: Westwood, Duncan organization: Sunnybrook Research Institute, ON, Canada – sequence: 7 givenname: Nick surname: Daneman fullname: Daneman, Nick organization: Public Health Ontario, ON, Canada – sequence: 8 givenname: Derek R. surname: MacFadden fullname: MacFadden, Derek R. organization: Ottawa Hospital Research Institute, ON, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33418017$$D View this record in MEDLINE/PubMed |
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| Copyright | 2021 Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved. Crown Copyright © 2021 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. All rights reserved. 2021 |
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| Keywords | COVID-19 SARS-CoV-2 Antimicrobial therapy Antibiotics Antimicrobial Stewardship Antibiotic Prescribing |
| Language | English |
| License | https://www.elsevier.com/tdm/userlicense/1.0 Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
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| SubjectTerms | Age Factors Anti-Bacterial Agents - therapeutic use Antibiotic Prescribing Antibiotics Antimicrobial Stewardship Antimicrobial therapy Bacterial Infections - complications Bacterial Infections - drug therapy Bacterial Infections - epidemiology Coinfection - drug therapy Coinfection - epidemiology COVID-19 COVID-19 - complications Drug Prescriptions Drug Utilization Female Humans Male SARS-CoV-2 Systematic Review |
| Title | Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis |
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