Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis

Bradley J Langford; Miranda So; Sumit Raybardhan; Valerie Leung; Jean-Paul R Soucy; Duncan Westwood; Nick Daneman; Derek R MacFadden

doi:10.1016/j.cmi.2020.12.018

Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis

Clin Microbiol Infect. 2021 Apr;27(4):520-531. doi: 10.1016/j.cmi.2020.12.018. Epub 2021 Jan 5.

Authors

Bradley J Langford¹, Miranda So², Sumit Raybardhan³, Valerie Leung⁴, Jean-Paul R Soucy⁵, Duncan Westwood⁶, Nick Daneman⁷, Derek R MacFadden⁸

Affiliations

¹ Public Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada. Electronic address: brad.langford@gmail.com.
² Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Canada; University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
³ North York General Hospital, ON, Canada.
⁴ Public Health Ontario, ON, Canada; Toronto East Health Network, Michael Garron Hospital, ON, Canada.
⁵ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
⁶ Sunnybrook Research Institute, ON, Canada.
⁷ Public Health Ontario, ON, Canada; University of Toronto, ON, Canada; Sunnybrook Research Institute, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), ON, Canada.
⁸ Ottawa Hospital Research Institute, ON, Canada.

Abstract

Background: 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.

Objective: The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.

Data sources: We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.

Study eligibility criteria: We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.

Participants: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Antibiotic Prescribing; Antibiotics; Antimicrobial Stewardship; Antimicrobial therapy; COVID-19; SARS-CoV-2.

Publication types

Meta-Analysis
Review

MeSH terms

Age Factors
Anti-Bacterial Agents / therapeutic use*
Antimicrobial Stewardship
Bacterial Infections / complications
Bacterial Infections / drug therapy
Bacterial Infections / epidemiology
COVID-19* / complications
Coinfection / drug therapy
Coinfection / epidemiology
Drug Prescriptions*
Drug Utilization*
Female
Humans
Male

Substances

Anti-Bacterial Agents