Co-infections and antimicrobial use among hospitalized COVID-19 patients in Punjab, Pakistan: findings from a multicenter, point prevalence survey

ABSTRACT

There are reports of high rates of antibiotic prescribing among hospitalized patients with COVID-19 around the world. To date, however, there are few reports of prescribing in relation to COVID-19 in Pakistan. Herein, we describe a point prevalence survey of antibiotic prescribing amongst patients hospitalized with suspected or proven COVID-19 in Pakistan. A Point Prevalence Survey (PPS) was undertaken in seven tertiary care health facilities in Punjab Provence, Pakistan. Baseline information about antimicrobial use according to the World Health Organization (WHO) standardized methodology was collected on a single day between 5^th and 30 April 2021. A total of 617 patients’ records were reviewed and 578 (97.3%) were documented to be receiving an antibiotic on the day of the survey. The majority (84.9%) were COVID-19 PCR positive, 61.1% were male and 34.9% were age 36 to 44 years. One quarter presented with severe disease, and cardiovascular disease was the major comorbidity in 13%. Secondary bacterial infection or co-infection (bacterial infection concurrent with COVID-19) was identified in only 1.4%. On the day of the survey, a mean of 1.7 antibiotics was prescribed per patient and 85.4% antibiotics were recorded as being prescribed for ‘prophylaxis’. The most frequently prescribed antibiotics were azithromycin (35.6%), ceftriaxone (32.9%) and meropenem (7.6%). The majority (96.3%) of the antibiotics were empirical and all were from WHO Watch or Reserve categories. Overall, a very high consumption of antibiotics in patients hospitalized with suspected or proven COVID-19 was observed in Pakistan and this is concerning in view of already high rates of antimicrobial resistance in the region. Antimicrobial stewardship programs need to urgently address unnecessary prescribing in the context of COVID-19 infection.

KEYWORDS:

• Hospitalized
• Covid-19
• antimicrobial
• use
• surveillance
• Punjab
• Pakistan

Acknowledgments

We would like to thank the pharmacists/pharmacy technicians and hospital administration for their support in the completion of this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Z.U.M. was responsible for the study concept. M.S.S., M.N.I, S.A.B and S.K. lead the organized data collection procedure. Z.U.M. and M.S. were involved in data analysis, interpretation of results and manuscript writing. B.G and R.A.S critically reviewed and edited the manuscript and contributed to data analysis. All authors read it carefully before submission.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

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Funding

The author(s) reported there is no funding associated with the work featured in this article.