Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis.
Antibiotic Prescribing
Antibiotics
Antimicrobial Stewardship
Antimicrobial therapy
COVID-19
SARS-CoV-2
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
01
09
2020
revised:
08
12
2020
accepted:
15
12
2020
pubmed:
9
1
2021
medline:
20
4
2021
entrez:
8
1
2021
Statut:
ppublish
Résumé
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. The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. 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). 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.
DATA SOURCES
METHODS
We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.
STUDY ELIGIBILITY CRITERIA
METHODS
We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.
PARTICIPANTS
METHODS
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
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
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
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.
Identifiants
pubmed: 33418017
pii: S1198-743X(20)30778-3
doi: 10.1016/j.cmi.2020.12.018
pmc: PMC7785281
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
520-531Informations de copyright
Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.
Références
Am J Transplant. 2020 Nov;20(11):3225-3233
pubmed: 32476258
BMC Infect Dis. 2020 Apr 29;20(1):311
pubmed: 32345226
J Clin Invest. 2020 May 1;130(5):2620-2629
pubmed: 32217835
Chest. 2020 Sep;158(3):939-946
pubmed: 32437696
N Engl J Med. 2020 Apr 2;382(14):1309-1319
pubmed: 32242356
Emerg Infect Dis. 2020 Aug;26(8):1679-1685
pubmed: 32407284
Ann Oncol. 2020 Jul;31(7):894-901
pubmed: 32224151
J Clin Virol. 2020 Jul;128:104425
pubmed: 32446167
Int J Infect Dis. 2020 Jul;96:266-269
pubmed: 32389850
Clin Infect Dis. 2020 Jul 28;71(15):706-712
pubmed: 32109279
N Engl J Med. 2020 May 7;382(19):1787-1799
pubmed: 32187464
J Microbiol Immunol Infect. 2021 Feb;54(1):54-60
pubmed: 32359943
Biomark Med. 2020 Jul;14(10):827-837
pubmed: 32490680
Int J Infect Dis. 2020 Jun;95:106-112
pubmed: 32272262
Infection. 2020 Oct;48(5):687-694
pubmed: 32390091
Clin Infect Dis. 2020 Nov 19;71(16):2035-2041
pubmed: 32249918
J Med Virol. 2020 Nov;92(11):2528-2535
pubmed: 32437017
Lancet. 2020 May 30;395(10238):1695-1704
pubmed: 32401715
J Zhejiang Univ Sci B. 2020 May;21(5):378-387
pubmed: 32425003
Lancet Infect Dis. 2017 Sep;17(9):990-1001
pubmed: 28629876
Infection. 2020 Aug;48(4):543-551
pubmed: 32342479
Curr Med Sci. 2020 Apr;40(2):275-280
pubmed: 32207032
Pediatr Pulmonol. 2020 Jun;55(6):1430-1432
pubmed: 32270592
JAMA Netw Open. 2020 Jun 1;3(6):e2010895
pubmed: 32492165
Allergy. 2020 Jul;75(7):1742-1752
pubmed: 32239761
Nat Med. 2020 Jun;26(6):861-868
pubmed: 32327757
Am J Obstet Gynecol. 2020 Jul;223(1):111.e1-111.e14
pubmed: 32335053
Clin Infect Dis. 2020 Nov 19;71(16):2121-2128
pubmed: 32442285
Front Cell Infect Microbiol. 2020 May 22;10:284
pubmed: 32574282
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
Lancet Gastroenterol Hepatol. 2020 Jun;5(6):534-535
pubmed: 32304638
Genes Dis. 2020 Dec;7(4):535-541
pubmed: 32363222
J Thorac Dis. 2020 May;12(5):1811-1823
pubmed: 32642086
J Clin Virol. 2020 Aug;129:104475
pubmed: 32485619
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Eur J Intern Med. 2020 Jun;76:36-42
pubmed: 32448770
Clin Infect Dis. 2020 Sep 12;71(6):1547-1551
pubmed: 32112072
Crit Care. 2020 May 14;24(1):219
pubmed: 32410714
Diabetes Care. 2020 Jul;43(7):1382-1391
pubmed: 32409504
Clin Infect Dis. 2020 Jul 28;71(15):769-777
pubmed: 32176772
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
JAC Antimicrob Resist. 2020 Sep;2(3):dlaa049
pubmed: 34192248
J Hosp Infect. 2020 Apr 14;:
pubmed: 32302722
J Allergy Clin Immunol. 2020 Jul;146(1):110-118
pubmed: 32294485
J Med Virol. 2020 Nov;92(11):2735-2741
pubmed: 32510173
Anaesth Crit Care Pain Med. 2020 Oct;39(5):553-561
pubmed: 32278670
Theranostics. 2020 May 15;10(14):6113-6121
pubmed: 32483442
J Med Virol. 2020 Jul;92(7):807-813
pubmed: 32222986
J Allergy Clin Immunol. 2020 Jul;146(1):137-146.e3
pubmed: 32470486
J Med Virol. 2021 Jan;93(1):357-365
pubmed: 32492209
J Infect. 2020 Jul;81(1):e1-e5
pubmed: 32171872
Pol Arch Intern Med. 2020 May 29;130(5):390-399
pubmed: 32329978
J Infect. 2020 Jul;81(1):e40-e44
pubmed: 32294503
J Clin Epidemiol. 2012 Sep;65(9):934-9
pubmed: 22742910
Gastroenterology. 2020 Sep;159(3):1170-1172.e1
pubmed: 32422208
Ann Transl Med. 2020 May;8(10):642
pubmed: 32566579
BMJ. 2020 Feb 19;368:m606
pubmed: 32075786
Lancet. 2020 May 16;395(10236):1569-1578
pubmed: 32423584
Am J Respir Crit Care Med. 2020 Jun 1;201(11):1380-1388
pubmed: 32275452
J Clin Pharm Ther. 2020 Aug;45(4):609-616
pubmed: 32449224
Diabetes Obes Metab. 2020 Oct;22(10):1897-1906
pubmed: 32469464
AJR Am J Roentgenol. 2020 Jul;215(1):127-132
pubmed: 32186894
Euro Surveill. 2020 Apr;25(16):
pubmed: 32347201
Emerg Infect Dis. 2020 Jul;26(7):1580-1585
pubmed: 32267826
Gut. 2020 Jun;69(6):1002-1009
pubmed: 32213556
Transpl Int. 2020 Sep;33(9):1099-1105
pubmed: 32460390
J Med Virol. 2020 Nov;92(11):2852-2856
pubmed: 32515499
Clin Pharmacol Ther. 2020 Oct;108(4):791-797
pubmed: 32324898
J Clin Med. 2020 Jun 02;9(6):
pubmed: 32498262
Clin Infect Dis. 2020 Nov 19;71(16):2276-2278
pubmed: 32407467
Crit Care. 2020 Apr 30;24(1):188
pubmed: 32354360
Pol Arch Intern Med. 2020 May 29;130(5):407-411
pubmed: 32420710
Clin Infect Dis. 2020 Nov 19;71(16):2167-2173
pubmed: 32444880
Med J Aust. 2020 May;212(9):416-420
pubmed: 32266987
Travel Med Infect Dis. 2020 May - Jun;35:101664
pubmed: 32278758
J Infect. 2020 Aug;81(2):266-275
pubmed: 32473235
Health Sci Rep. 2020 Jul 27;3(3):e178
pubmed: 32728636
J Pediatr. 2020 Aug;223:14-19.e2
pubmed: 32407719
Influenza Other Respir Viruses. 2020 Sep;14(5):564-574
pubmed: 32397011
Lancet Oncol. 2020 Jul;21(7):893-903
pubmed: 32479790
J Clin Lab Anal. 2020 Jul;34(7):e23391
pubmed: 32488888
Phytomedicine. 2021 May;85:153242
pubmed: 33867046
Diabetes Obes Metab. 2020 Oct;22(10):1935-1941
pubmed: 32314455
Clin Microbiol Infect. 2020 Jul;26(7):808-810
pubmed: 32360446
J Antimicrob Chemother. 2020 Jul 1;75(7):1681-1684
pubmed: 32433765
J Am Soc Nephrol. 2020 Jul;31(7):1387-1397
pubmed: 32385130
Circulation. 2020 Jul 14;142(2):114-128
pubmed: 32421381
J Infect. 2020 Aug;81(2):e148-e149
pubmed: 32512022
JCI Insight. 2020 Jun 18;5(12):
pubmed: 32427582
Acta Obstet Gynecol Scand. 2020 Jul;99(7):839-847
pubmed: 32441332
J Med Virol. 2020 Oct;92(10):2055-2066
pubmed: 32369208
Crit Care. 2020 Jun 5;24(1):299
pubmed: 32503617
Clin Infect Dis. 2020 Jul 28;71(15):748-755
pubmed: 32239127
J Clin Virol. 2020 Jun;127:104353
pubmed: 32302953
EClinicalMedicine. 2020 Apr 05;21:100331
pubmed: 32292899
Allergy. 2020 Jul;75(7):1699-1709
pubmed: 32196678
Euro Surveill. 2020 Apr;25(17):
pubmed: 32372754
Pharmacol Res. 2020 Aug;158:104931
pubmed: 32446978
Int J Clin Pharm. 2020 Jun;42(3):837-845
pubmed: 32410206
Yonsei Med J. 2020 May;61(5):431-437
pubmed: 32390367
Travel Med Infect Dis. 2020 Jul - Aug;36:101606
pubmed: 32114074
Sci China Life Sci. 2020 May;63(5):706-711
pubmed: 32146694
Clin J Am Soc Nephrol. 2020 Aug 7;15(8):1139-1145
pubmed: 32444393
J Clin Virol. 2020 Jun;127:104377
pubmed: 32361323
Clin Transl Sci. 2020 Nov;13(6):1077-1086
pubmed: 32315487
Am J Transplant. 2020 Oct;20(10):2876-2882
pubmed: 32412159
Clin Epidemiol. 2020 Apr 09;12:387-391
pubmed: 32308494
J Clin Lab Anal. 2020 Sep;34(9):e23415
pubmed: 32488958
Chin Med J (Engl). 2020 May 5;133(9):1032-1038
pubmed: 32118640
Clin Infect Dis. 2020 Nov 19;71(16):2114-2120
pubmed: 32427279
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
Travel Med Infect Dis. 2020 Jul - Aug;36:101782
pubmed: 32526372
JAMA Cardiol. 2020 Jul 1;5(7):802-810
pubmed: 32211816
Clin Microbiol Infect. 2020 Dec;26(12):1622-1629
pubmed: 32711058
JAC Antimicrob Resist. 2020 Sep;2(3):dlaa053
pubmed: 34192250
Diabetes Res Clin Pract. 2020 Jul;165:108227
pubmed: 32446795
J Cyst Fibros. 2020 May;19(3):355-358
pubmed: 32376098
Aging (Albany NY). 2020 Jun 4;12(11):10070-10086
pubmed: 32499448
J Acquir Immune Defic Syndr. 2020 Sep 1;85(1):e4-e5
pubmed: 32483000
Lancet. 2018 Jun 2;391(10136):2236-2271
pubmed: 29893224
J Intern Med. 2020 Jul;288(1):128-138
pubmed: 32220033
Int J Infect Dis. 2020 Jun;95:183-191
pubmed: 32173576
Eur J Clin Microbiol Infect Dis. 2019 Dec;38(12):2275-2281
pubmed: 31478103
Front Med (Lausanne). 2020 May 12;7:210
pubmed: 32574322
Int J Biol Sci. 2020 Mar 15;16(10):1698-1707
pubmed: 32226287
J Med Virol. 2020 Oct;92(10):2146-2151
pubmed: 32401361
Ann Transl Med. 2020 Apr;8(7):443
pubmed: 32395487
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Epidemiology. 2020 Sep;31(5):713-717
pubmed: 32657954
Proc Natl Acad Sci U S A. 2020 Apr 28;117(17):9490-9496
pubmed: 32253318
J Crit Care. 2020 Aug;58:29-33
pubmed: 32330817
Kidney Int. 2020 Jun;97(6):1083-1088
pubmed: 32354634
J Clin Virol. 2020 Jun;127:104361
pubmed: 32344320
Clin Infect Dis. 2020 Dec 3;71(9):2459-2468
pubmed: 32358954
Clin Microbiol Infect. 2020 Oct;26(10):1395-1399
pubmed: 32603803
Am J Gastroenterol. 2020 May;115(5):766-773
pubmed: 32287140
Ann Transl Med. 2020 Apr;8(8):547
pubmed: 32411770
Clin Gastroenterol Hepatol. 2020 Jun;18(7):1561-1566
pubmed: 32283325
Crit Care Med. 2020 Jun;48(6):e440-e469
pubmed: 32224769
Epidemiol Infect. 2020 May 06;148:e94
pubmed: 32374248
Lancet. 2020 Jun 6;395(10239):1763-1770
pubmed: 32442528
Am J Transplant. 2020 Jul;20(7):1819-1825
pubmed: 32351040
Kidney Int. 2020 Jul;98(1):20-26
pubmed: 32437768
JAMA. 2020 Aug 4;324(5):460-470
pubmed: 32492084
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
JAC Antimicrob Resist. 2020 Sep;2(3):dlaa051
pubmed: 34192249
J Intern Med. 2020 Sep;288(3):335-344
pubmed: 32352202
J Infect Chemother. 2020 Aug;26(8):865-869
pubmed: 32405245
World J Pediatr. 2020 Jun;16(3):260-266
pubmed: 32504360
Ann Am Thorac Soc. 2020 Jul;17(7):839-846
pubmed: 32255382
Eur Urol. 2020 Aug;78(2):281-286
pubmed: 32409114
Lancet. 2020 Feb 15;395(10223):507-513
pubmed: 32007143
Chin Med J (Engl). 2020 Jun 5;133(11):1261-1267
pubmed: 32209890
J Clin Med. 2020 Jun 03;9(6):
pubmed: 32503180
J Infect. 2020 Jun;80(6):e14-e18
pubmed: 32171866
Leukemia. 2020 Jun;34(6):1637-1645
pubmed: 32332856
Gerontology. 2020;66(5):467-475
pubmed: 32474561
Chest. 2020 Jul;158(1):97-105
pubmed: 32304772
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
Int J Gynaecol Obstet. 2020 Aug;150(2):264-266
pubmed: 32438521
Clin Microbiol Infect. 2020 Jul;26(7):917-921
pubmed: 32344167
J Gerontol A Biol Sci Med Sci. 2020 Sep 16;75(9):1796-1800
pubmed: 32506122
Otolaryngol Head Neck Surg. 2020 Jul;163(1):170-178
pubmed: 32423368
BMJ. 2020 May 29;369:m1996
pubmed: 32471884
Am J Respir Crit Care Med. 2020 Jun 1;201(11):1430-1434
pubmed: 32267160
Eur Radiol. 2020 Oct;30(10):5702-5708
pubmed: 32385648
Pharmacol Res. 2020 Jul;157:104821
pubmed: 32360481
PLoS Negl Trop Dis. 2020 May 8;14(5):e0008280
pubmed: 32384078
Influenza Other Respir Viruses. 2016 Sep;10(5):394-403
pubmed: 27232677
Infect Control Hosp Epidemiol. 2016 May;37(5):583-9
pubmed: 26832841
Clin Infect Dis. 2021 May 4;72(9):1657-1659
pubmed: 32544232
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100134
pubmed: 32391519
Lancet Rheumatol. 2020 Jun;2(6):e325-e331
pubmed: 32501454
Int J Infect Dis. 2020 Jun;95:421-428
pubmed: 32289565