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ABSTRACT
Background
The coronavirus disease (COVID-19) led to a global health crisis. Inappropriate use of antibiotics in COVID-19 patients has been a concern, leading to antimicrobial resistance. This study evaluated the patterns and predictors of empirical antibiotic therapy in COVID-19 patients and associated outcomes.
Methods
A hospital-based retrospective study was conducted with 525 patients admitted to Kasturba Hospital, Manipal, India, with moderate and severe COVID-19 from 1 March to 1 August 2021. They were divided based on empirical therapy, and predictors of antibiotic usage were assessed by logistic regression.
Results
Four hundred and eighty (91.4%) COVID-19 patients received at least one course of antibiotics, with 440 (83.8%) initiating empirical therapy. Patients with severe COVID-19 manifestations were more likely to be prescribed empirical antibiotics. Multivariable analysis showed that patients initiated on empirical antibiotics had significantly elevated levels of procalcitonin [OR: 3.91 (95% CI: 1.66–9.16) (p = 0.001)], invasive ventilation [OR: 3.93 (95% CI: 1.70–9.09) (p = 0.001)], shortness of breath [OR: 2.25 (95% CI: 1.30–3.89) (p = 0.003)] and higher CRP levels [OR: 1.01 (95% CI: 1.00–1.01) (p = 0.005)]. Most antibiotics (65.9%) were prescribed from the ‘Watch’ group, the highest being ceftriaxone. Only 23.8% of the patients had microbiologically confirmed infections.
Conclusion
The study identified predictors for initiating empirical antibacterial therapy in our setting.
Declaration of Interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
The authors gratefully acknowledge the help and facilities provided by Manipal College of Pharmaceutical Sciences, Kasturba Hospital, Manipal, Manipal Center for Infectious Diseases and Manipal Academy of Higher Education, Manipal, India.
Ethics statement
Ethical approval was obtained from the Institutional Ethics Committee (IEC) of Kasturba Medical College and Kasturba Hospital (KMC&KH), Manipal (Reference No: IEC 693/2021, dated 8 January 2022). The study was registered in the Clinical Trial Registry of India (CTRI), Reg No: CTRI/2022/01/039784.
Data availability statement
The dataset used or analyzed during the current study available from the corresponding author on reasonable request.
Author contribution statement
Lipin Lukose, Gursimran Kaur, Kanav Khera, Viswam K Subeesh, Ronald L Castelino, and Sonal Sekhar Miraj conceptualized the study. Lipin Lukose and Gursimran Kaur collected the data. Gail Ann Abraham, Mohammed Asif M, Sonal Sekhar Miraj, and Shubhada Karanth cured the data. Lipin Lukose, Gursimran Kaur, and Viswam K Subeesh analyzed the data. Lipin Lukose, Gursimran Kaur, and Sonal Sekhar Miraj wrote the manuscript. Viswam K Subeesh, Kanav Khera, Ronald L Castelino, Shubhada Karanth, Chandrashekar Udyavara Kudru, Muralidhar Varma, and Sonal Sekhar Miraj critically evaluated the manuscript. All the authors participated in the manuscript review and approved the final draft of the revised manuscript. All authors agreed on the submission of the manuscript to the journal. All authors had access to the study data and took responsibility for the integrity of the data and the accuracy of the data analysis.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2024.2303019