Mismanagement of SARS-CoV-2 Infection Pre Hospitalisation during the Omicron Era: Antibiotics and Steroids Instead of Early Antivirals

• Published in: Viruses Vol. 16; no. 7; p. 1005
• Main Authors: Giacomelli, Andrea, Ciubotariu, Cosmin Lucian, Zacheo, Martina, Rabbione, Andrea, Pieruzzi, Margherita, Barone, Federico, Poloni, Andrea, Casalini, Giacomo, Pozza, Giacomo, Colaneri, Marta, Passerini, Matteo, Ridolfo, Anna Lisa, Gervasoni, Cristina, Cattaneo, Dario, Gori, Andrea, Antinori, Spinello
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.07.2024
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antigens; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Bacterial infections; Contraindications; COVID-19; COVID-19 - epidemiology; COVID-19 Drug Treatment; COVID-19 infection; Creatinine; Disease; Drug interactions; Emergency medical care; Female; Health aspects; Hospitalization; Hospitals; Humans; inappropriate treatment; Infections; Italy - epidemiology; Male; Middle Aged; Monoclonal antibodies; nirmatrelvir/ritonavir; observational studies; Omicron; Pandemics; Patients; Resveratrol; Retrospective Studies; SARS-CoV-2 - drug effects; Sea level; Severe acute respiratory syndrome coronavirus 2; Steroid hormones; Steroids; Steroids (Drugs); Steroids - therapeutic use; Vaccination; World health; Italy; COVID-19; inappropriate treatment; nirmatrelvir/ritonavir; steroids; Omicron; antibiotics
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v16071005

The aim of this study was to assess the prevalence of inappropriate treatment among hospitalised patients affected by SARS-CoV-2 infection before hospital admission during the Omicron era. This single-centre, retrospective observational study included all the patients hospitalised because of SARS-CoV-2 infection during three periods characterised by the Italian prevalence of an Omicron variant of concern: (1) January–May 2022 (BA.1–BA.2), (2) June–October 2022 (BA.5), and (3) November 2022–March 2023 (BQ.1-XBB). Inappropriate treatment was defined as pre-hospitalisation exposure to antibiotics and/or steroids in the absence of a documented bacterial infection or the need for steroid treatment of an underlying medical condition. A total of 931 subjects were hospitalised: 394 in period 1, 334 in period 2, and 203 in period 3. Of the 157 patients undergoing inappropriate treatment (16.9%), 142 (15.3%) received antibiotics and 52 (5.6%) steroids. The proportion of inappropriately treated patients significantly decreased over time, from 23.1% in period 1 to 11.7% in period 2 and 13.3% in period 3 (p < 0.001), and there was a parallel decrease in antibiotic (p < 0.001) and steroid treatment (p < 0.013). Only 13 subjects (1.4%) received early pre-hospitalisation treatment for SARS-CoV-2. A significant proportion of hospitalised COVID-19 patients were exposed to inappropriate treatment before hospital admission.