A systematic review and meta-analysis of studies published during the first 18 months of the COVID-19 pandemic provides further evidence that antibiotic use far exceeded the prevalence of bacterial co-infection, researchers reported this week in BMC Infectious Diseases.
The review included 85 studies, mostly from China (29) and the United States (16), involving more than 30,000 patients. Of the 70 studies that reported on the prevalence of bacterial co-infection, the meta-analysis showed an overall prevalence of bacterial co-infection of 12%. But among the 20 studies that gave a clear definition of bacterial co-infection, the overall prevalence was only 4%. Meta-analysis of the 52 studies that included data on antibiotic use showed that the overall antibiotic use rate was 60%, and the empiric antibiotic use rate was 62%.
The study authors note that the results are similar to other meta-analyses that have been conducted on antibiotic use and bacterial co-infections in COVID-19 patients, although their results showed a slightly lower rate of antibiotic use. They suggest this could reflect changes in empiric antibiotic use as clinicians gained more experience in managing COVID-19 and more data became available to inform evidence-based practice regarding antibiotic use.
There is currently insufficient evidence to support the empirical use of antibiotics in most hospitalised patients with COVID-19.
"Our results show that there is currently insufficient evidence to support the use of empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection in these patients is low," they wrote. "Furthermore, as the use of antibiotics in COVID-19 appears to have been largely empirical, it is necessary to identify clinical and laboratory markers and to formulate guidelines to promote more targeted administration of antibiotics in patients admitted to hospital with COVID-19."
The authors say they hope the study can help clinicians "reflect on and understand the initial response to a global pandemic of a novel respiratory virus."