Stewardship / Resistance Scan for Aug 03, 2022

Antibiotic overuse in COVID-19 patients
End-of-life antibiotic use

Meta-analysis finds antibiotic use common in COVID-19 patients

In findings that are consistent with previous studies, a systematic review and analysis of 22 studies revealed a high rate of antibiotic use among COVID-19 patients during the first year and a half of the pandemic, despite a low prevalence of bacterial coinfection, researchers reported this week in PLOS One.

To determine the prevalence of bacterial coinfection and antibiotic use among patients with laboratory-confirmed COVID-19, a team of researchers in Scotland reviewed English-language studies published from January 2020 through June 2021. Of the 1,058 studies screened, 22 hospital-based studies were eligible, comprising 76,167 patients. Most of the studies included in the review were conducted in the United States (10), United Kingdom (4), and China (3), with 1 study each in France, Germany, Indonesia, the Netherlands, and Spain. The mean age of patients was 61 years, and 54% of subjects were male.

Random-effects meta-analysis of all combined studies estimated that the prevalence of bacterial coinfection and antibiotic use in COVID-19 patients was 5.62% (95% confidence interval [CI], 2.26% to 10.31%) and 61.77% (95% CI, 50.95% to 70.90%), respectively. Sub-group analysis showed that bacterial coinfection (7.89%; 95% CI, 3.30% to 14.18%) and antibiotic use (68.84%; 95% CI, 62.27% to 75.05%) was highest in North America.

"The results from this review demonstrates that there is insufficient evidence supporting considerable empiric antibiotic prescribing in patients with COVID-19 due to a low prevalence of bacterial coinfection," the study authors wrote. "Nonetheless, antibiotics use was high, mirroring the findings in other reviews. As the pandemic evolves, and new COVID-19 specific therapeutics come into clinical practice, it will be important to assess their impact on antibiotic use." 
Aug 1 PLOS One study


VA study shows high antibiotic use during end-of-life care

A nationwide study of Veterans Affairs (VA) patients found high levels of antibiotic exposure during end-of-life (EOL) care, researchers reported yesterday in Clinical Microbiology and Infection.

The retrospective cohort study, conducted by researchers with the Iowa City VA Health Care System and the University of Iowa Carver College of Medicine, analyzed a cohort of VA patients who died from January 2014 through December 2019 and had been hospitalized within 6 months prior to death.

The researchers looked at demographics, comorbid conditions, duration of inpatient antibiotics administered, and outpatient antibiotics dispensed. They then compared antibiotic use in hospitalized VA patients placed into palliative care or hospice versus hospitalized patients who did not receive palliative or hospice care.

Of the 101,208 patients who died during the study period, 9,808 were in hospice care and 40,796 received a palliative care consult, and they were matched to 50,604 patients without palliative or hospice care.

Within 14 days of placement or consultation, 41% (4,040/9,808) of hospice patients and 48% (19,735/40,796) of palliative care patients received at least one antibiotic, while 25% (2,420/9,808) of matched non-hospice and 27% (10,991/40,796) of matched non-palliative care patients received antibiotics. Entry into hospice was independently associated with a 12% absolute increase in antibiotic prescribing (as measured by days of therapy) and entry into palliative care was associated with a 17% absolute increase during the 14 days post-entry versus pre-entry period.

The study authors note that while patients at the EOL are more susceptible to infection, the decision of whether or not to prescribe an antibiotic poses a unique challenge, since it will not likely change the ultimate outcome.

"Rather than focusing on cure, palliative and hospice goals of care typically include minimizing suffering and maximizing quality of life," they wrote. "However, how these goals apply to antibiotic use at the EOL remains unclear."

The authors go on to say that future studies are needed to identify optimal targets during EOL for collaboration between antibiotic stewardship programs and hospice or palliative care teams.
Aug 2 Clin Microbiol Infect abstract

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