Patterns of In-patient Antibiotic Use among COVID-19 Patients in a Tertiary Government Hospital: A Retrospective Cross-sectional Survey

Abstract

Background. The occurrence of the COVID-19 pandemic resulted in increased risk of developing antimicrobial resistance due to the high utilization of antimicrobial agents. Since antimicrobial utilization is a crucial driver in the development of antimicrobial resistance, the need for antimicrobial use surveillance is crucial in identifying prescription patterns that would help provide proper interventions.

Objective. To determine the antibiotic use and prevalence of prescription quality indicators among COVID-19 patients admitted at a tertiary government hospital.

Methods. A retrospective cross-sectional survey was conducted to provide data on antibiotic use and the prevalence of prescription quality indicators among COVID-19 patients in a tertiary-level hospital from June 2021 to June 2022.

Results. A total of 342 patient medical records were surveyed. The majority (119, 34.8%) of the patients were in the age group 41-60 years old and there were more male patients (52.34%) than female patients (47.66%). About 88.99% of the patients were considered to have community-acquired COVID-19 infections. Co-morbidities among patients were seen in more than half of the surveyed population (64%). These include hypertension, diabetes mellitus, chronic kidney disease, coronary artery disease, chronic lung disease, and hematologic disorders.

Empiric antibiotic therapy was high at 88.88%, while definitive treatment with confirmed bacterial infection was only at 11.11%. The most frequently prescribed antibiotic therapies are azithromycin (250, 45.9%), ceftriaxone (188, 32.2%), and cefuroxime (58, 9.9%). Patterns of antibiotic use are attributed to the similarities of respiratory bacterial infections with COVID-19 cases.

Prescription quality indicators assessed in the study include documentation of indication for prescriptions, guideline compliance, collection of culture before antibiotic therapy, and stop/review documentation. Out of 583 antibiotic prescriptions, 464 (79.58%) were properly documented with an indication. Non-compliance to guidelines reached 39.11%, while the stop and review date documentation rate was 20.41%. The collection of culture before the start of antibiotic therapy was at 50.2%.

Conclusion. The results from the study highlighted the need for antimicrobial surveillance and stewardship efforts among COVID-19 and other viral infections.