Journal article
Antibiotic Use and Bacterial Infection among Inpatients in the First Wave of COVID-19: a Retrospective Cohort Study of 64,691 Patients
Antimicrobial agents and chemotherapy, Vol.65(11), p.e0134121
10/18/2021
DOI: 10.1128/AAC.01341-21
PMID: 34491806
Abstract
Hospitalized patients with SARS-CoV-2 infection (COVID-19) often receive antibiotics for suspected bacterial coinfection. We estimated the incidence of bacterial coinfection and secondary infection in COVID-19 using clinical diagnoses to determine how frequently antibiotics are administered when bacterial infection is absent. We performed a retrospective cohort study of inpatients with COVID-19 present on admission to hospitals in the Premier Healthcare Database between April and June 2020. Bacterial infections were defined using ICD-10-CM diagnosis codes and associated "present on admission" coding. Coinfections were defined by bacterial infection present on admission, while secondary infections were defined by bacterial infection that developed after admission. Coinfection and secondary infection were not mutually exclusive. A total of 18.5% of 64,961 COVID-19 patients (n = 12,040) presented with bacterial infection at admission, 3.8% (n = 2,506) developed secondary infection after admission, and 0.9% (n = 574) had both; 76.3% (n = 49,551) received an antibiotic while hospitalized, including 71% of patients who had no diagnosis of bacterial infection. Secondary bacterial infection occurred in 5.7% of patients receiving steroids in the first 2 days of hospitalization, 9.9% receiving tocilizumab in the first 2 days of hospitalization, and 10.3% of patients receiving both. After adjusting for patient and hospital characteristics, bacterial coinfection (adjusted relative risk [aRR], 1.15; 95% confidence interval [CI], 1.11 to 1.20) and secondary infection (aRR 1.93; 95% CI, 1.82 to 2.04) were both independently associated with increased mortality. Although 1 in 5 inpatients with COVID-19 presents with bacterial infection, secondary infections in the hospital are uncommon. Most inpatients with COVID-19 receive antibiotic therapy, including 71% of those not diagnosed with bacterial infection.
Details
- Title: Subtitle
- Antibiotic Use and Bacterial Infection among Inpatients in the First Wave of COVID-19: a Retrospective Cohort Study of 64,691 Patients
- Creators
- Jonathan D. Baghdadi - University of Maryland, BaltimoreK. C. Coffey - University of Maryland, BaltimoreTimileyin Adediran - University of MichiganKatherine E. Goodman - University of Maryland, BaltimoreLisa Pineles - University of Maryland, BaltimoreLarry S. Magder - University of Maryland, BaltimoreLyndsay M. O'Hara - Univ Maryland, Dept Epidemiol & Publ Hlth, Sch Med, Baltimore, MD 21201 USABeth L. Pineles - The University of Texas Health Science Center at HoustonGita Nadimpalli - University of Maryland, BaltimoreDaniel J. Morgan - VA Maryland Health Care SystemAnthony D. Harris - University of Maryland, Baltimore
- Resource Type
- Journal article
- Publication Details
- Antimicrobial agents and chemotherapy, Vol.65(11), p.e0134121
- DOI
- 10.1128/AAC.01341-21
- PMID
- 34491806
- NLM abbreviation
- Antimicrob Agents Chemother
- ISSN
- 0066-4804
- eISSN
- 1098-6596
- Publisher
- Amer Soc Microbiology
- Number of pages
- 10
- Grant note
- Merck; Merck & Company 1KL2TR003099-03; 1UL1TR003098-03 / University of Maryland Baltimore Institute for Clinical & Translational Research/Clinical and Translational Science Award
- Language
- English
- Date published
- 10/18/2021
- Academic Unit
- Epidemiology
- Record Identifier
- 9985123696202771
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