Prevalence of Empiric Antibacterial Therapy, Community-Acquired Bacterial Superinfection, and Antibiotic-Associated Adverse Reactions among Patients with COVID-19 Pneumonia Admitted in Makati Medical Center from March 2020 to March 2021

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus which was first discovered in Wuhan, China. Being a viral illness, antibacterial agents theoretically have no role in patients with pure COVID-19 infection. However, like any viral illness, concomitant bacterial infection may occur. The dilemma of starting an antibacterial agent in a COVID-19 patient remains a debate since the use of antibacterial agents may pose a risk of developing antibiotic-associated adverse events such as the emergence of drug-resistant pathogens and other antibiotic-associated drug toxicity. The primary objective of the study is to determine the amount of empiric antibacterial prescription done by physicians among admitted patients with COVID-19 infection as well as the trend of antibiotic prescription by physicians during the past 12 months of the COVID-19 pandemic. The secondary objective was to determine and quantify antibiotic-associated adverse effects. MATERIALS AND METHODS: This is a retrospective cohort study wherein charts of patients admitted for COVID-19 last March 2020 to March 2021 were reviewed and analyzed. Empiric antibiotic prescription during the first 48 hours of admission was noted as well as the proportion of concomitant bacterial infections. Development of antibiotic-associated adverse events such as the development of the multidrug-resistant organism and fungal infections, Clostridiodes difficile and/or gastrointestinal side effects, and hypersensitivity reactions were also noted. RESULTS: Results showed that among the 895 patients with COVID-19 admitted, 533 (59.6%) patients were started antibiotics during the first 48 hours of admission. Among those patients who are started with antibacterial therapy during the first 48 hours of admission, 60 (15.3%) patients had bacterial coinfection. The prevalence of antibiotic-associated adverse events was 46.9%, the most common of which was gastrointestinal reactions. The overall mortality rate of the patients given antibiotics was 18.8%. The median length of hospital stay was 11 days. CONCLUSION: Community-acquired bacterial infections in COVID-19 patients admitted during the study period were low while empiric antibiotic prescription was high especially during the first few months of the pandemic, especially during the surge. Antibiotic-related adverse effects were high. There was a noted decreasing trend of antibiotic prescription during the latter part of the pandemic when new developments in COVID-19 treatment were discovered. All in all, routine antibacterial prescription in patients with COVID-19 is not recommended given the real-world data in this study.