TY - JOUR
T1 - Early Empiric Antibiotic Use in Patients Hospitalized With COVID-19
T2 - A Retrospective Cohort Study
AU - On behalf of the N3C Consortium
AU - Widere, J. Christian
AU - Davis, Claire Leilani
AU - Loomba, Johanna Jean
AU - Bell, Taison D.
AU - Enfield, Kyle B.
AU - Barros, Andrew Julio
AU - Amor, Benjamin
AU - Bissell, Mark M.
AU - Bradwell, Katie Rebecca
AU - Girvin, Andrew T.
AU - Manna, Amin
AU - Qureshi, Nabeel
AU - Chute, Christopher G.
AU - Pfaff, Emily R.
AU - Gabriel, Davera
AU - Hong, Stephanie S.
AU - Kostka, Kristin
AU - Lehmann, Harold P.
AU - Moffitt, Richard A.
AU - Morris, Michele
AU - Palchuk, Matvey B.
AU - Zhang, Xiaohan Tanner
AU - Zhu, Richard L.
AU - Austin, Christopher P.
AU - Gersing, Kenneth R.
AU - Bozzette, Samuel
AU - Deacy, Mariam
AU - Garbarini, Nicole
AU - Kurilla, Michael G.
AU - Michael, Sam G.
AU - Rutter, Joni L.
AU - Temple-O'Connor, Meredith
AU - Haendel, Melissa A.
AU - Bennett, Tellen D.
AU - Chute, Christopher G.
AU - Eichmann, David A.
AU - Guinney, Justin
AU - Kibbe, Warren A.
AU - Liu, Hongfang
AU - Payne, Philip R.O.
AU - Pfaff, Emily R.
AU - Robinson, Peter N.
AU - Saltz, Joel H.
AU - Spratt, Heidi
AU - Starren, Justin
AU - Suver, Christine
AU - Wilcox, Adam B.
AU - Williams, Andrew E.
AU - Wu, Chunlei
AU - Pfaff, Emily R.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - OBJECTIVE: To investigate temporal trends and outcomes associated with early antibiotic prescribing in patients hospitalized with COVID-19. DESIGN: Retrospective propensity-matched cohort study using the National COVID Cohort Collaborative (N3C) database. SETTING: Sixty-six health systems throughout the United States that were contributing to the N3C database. Centers that had fewer than 500 admissions in their dataset were excluded. PATIENTS: Patients hospitalized with COVID-19 were included. Patients were defined to have early antibiotic use if they received at least 3 calendar days of intravenous antibiotics within the first 5 days of admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 322,867 qualifying first hospitalizations, 43,089 patients received early empiric antibiotics. Antibiotic use declined across all centers in the data collection period, from March 2020 (23%) to June 2022 (9.6%). Average rates of early empiric antibiotic use (EEAU) also varied significantly between centers (deviance explained 7.33% vs 20.0%, p < 0.001). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (odds ratio [OR] 3.57; 95% CI, 3.42-3.72), extracorporeal membrane oxygenation before day 2 (OR 2.14; 95% CI, 1.75-2.61), and early vasopressor use (OR 1.85; 95% CI, 1.78-1.93) but not region of residence was associated with EEAU. After propensity matching, EEAU was associated with an increased risk for in-hospital mortality (OR 1.27; 95% CI, 1.23-1.33), prolonged mechanical ventilation (OR 1.65; 95% CI, 1.50-1.82), late broad-spectrum antibiotic exposure (OR 3.24; 95% CI, 2.99-3.52), and late Clostridium difficile infection (OR 1.60; 95% CI, 1.37-1.87). CONCLUSIONS: Although treatment of COVID-19 patients with empiric antibiotics has declined during the pandemic, the frequency of use remains high. There is significant inter-center variation in antibiotic prescribing practices and evidence of potential harm. Our findings are hypothesis-generating and future work should prospectively compare outcomes and adverse events.
AB - OBJECTIVE: To investigate temporal trends and outcomes associated with early antibiotic prescribing in patients hospitalized with COVID-19. DESIGN: Retrospective propensity-matched cohort study using the National COVID Cohort Collaborative (N3C) database. SETTING: Sixty-six health systems throughout the United States that were contributing to the N3C database. Centers that had fewer than 500 admissions in their dataset were excluded. PATIENTS: Patients hospitalized with COVID-19 were included. Patients were defined to have early antibiotic use if they received at least 3 calendar days of intravenous antibiotics within the first 5 days of admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 322,867 qualifying first hospitalizations, 43,089 patients received early empiric antibiotics. Antibiotic use declined across all centers in the data collection period, from March 2020 (23%) to June 2022 (9.6%). Average rates of early empiric antibiotic use (EEAU) also varied significantly between centers (deviance explained 7.33% vs 20.0%, p < 0.001). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (odds ratio [OR] 3.57; 95% CI, 3.42-3.72), extracorporeal membrane oxygenation before day 2 (OR 2.14; 95% CI, 1.75-2.61), and early vasopressor use (OR 1.85; 95% CI, 1.78-1.93) but not region of residence was associated with EEAU. After propensity matching, EEAU was associated with an increased risk for in-hospital mortality (OR 1.27; 95% CI, 1.23-1.33), prolonged mechanical ventilation (OR 1.65; 95% CI, 1.50-1.82), late broad-spectrum antibiotic exposure (OR 3.24; 95% CI, 2.99-3.52), and late Clostridium difficile infection (OR 1.60; 95% CI, 1.37-1.87). CONCLUSIONS: Although treatment of COVID-19 patients with empiric antibiotics has declined during the pandemic, the frequency of use remains high. There is significant inter-center variation in antibiotic prescribing practices and evidence of potential harm. Our findings are hypothesis-generating and future work should prospectively compare outcomes and adverse events.
KW - COVID-19
KW - antimicrobial prescribing
KW - bacterial coinfection
KW - drug resistance
KW - pneumonia
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U2 - 10.1097/CCM.0000000000005901
DO - 10.1097/CCM.0000000000005901
M3 - Article
C2 - 37125800
AN - SCOPUS:85168251224
SN - 0090-3493
VL - 51
SP - 1168
EP - 1176
JO - Critical care medicine
JF - Critical care medicine
IS - 9
ER -