Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID
Jorge Calderón‐Parra, Antonio Muiño-Míguez, Alejandro David Bendala Estrada, António Ramos, Elena Múñez, Eduardo Fernández Carracedo, Javier Tejada Montes, Manuel Rubio‐Rivas, Francisco Arnalich, José Luis Beato Pérez, José Miguel García Bruñén, Esther del Corral Beamonte, Paula María Pesqueira Fontán, María del Mar Tomás Carmona, Rosa Fernández-Madera Martínez, Andrés González García, Cristina Salazar Mosteiro, Carlota Tuñón de Almeida, Julio González Moraleja, F Déodati, María Dolores Martín Escalante, María Luisa Asensio Tomás, Ricardo Gómez‐Huelgas, José Manuel Casas Rojo, Jesús Millán Núñez-Cortés, for the SEMI-COVID-19 Network
Abstract
BACKGROUND: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. METHODS: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. RESULTS: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). CONCLUSION: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful.