Antibiotic prescriptions for suspected or confirmed respiratory tract infection during COVID-19 : a retrospective study of antibiotic prescription's appropriateness. Assessment of the practices in the Grand Hôpital de Charleroi

Details

Supervisors

Thys, Frédéric ; Van Wetter, Céline ; Holemans, Xavier

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

Background. Confirmed bacterial co-infection seems rare in COVID-19 patients but antibiotic prescription in hospitalized patients are high. The Grand Hôpital de Charleroi has been an important center for hospitalized COVID-19 patients in Belgium. Objectives. The primary outcome is to assess the percentage of appropriate antibiotic prescription initiation during the COVID-19 pandemic. The second objective is the conformity assessment of 1) the molecule, 2) the dosage, 3) the route of administration and 4) the duration of each antibiotic prescription based on the local recommendations. A comparison of the two main objectives between the 2 first waves of the pandemic was made. Method. This retrospective study performed a qualitative assessment of antibiotic prescriptions in COVID-19 adult patients hospitalized between 1st April 2020 and 31st December 2020 for respiratory symptoms. Demographics, clinical and biological data were collected as well as antibiotic information. Bacterial co-infection diagnosis was admitted when there was presence of a lobar consolidation on a chest X ray or a CT scan, a positive blood culture suggestive of a respiratory tract infection, a positive respiratory expectoration and/or a positive urinary antigen test for Legionella pneumophila or Streptococcus pneumonia. A first classification of antibiotic’s initiation, length, molecule, dose and route of administration’s appropriateness was made by a student in advanced master of hospital pharmacy. Then, an adjudication committee (an infectious disease physician, a pulmonologist, an intensivist and a geriatrician) reviewed all the judgements. Each physician evaluated the cases of their own field. Findings. A little majority (52,9%, 200/378) of hospitalized COVID-19 patients were prescribed antibiotics. Out of those, 107 patients (28,3%, 107/378) presented a bacterial co-infection. Antibiotic initiation was justified in 53.5% of the cases (107/200). A total of 353 antibiotics were prescribed. A third (34.3%, 121/353) of all antibiotics were perfectly administered following the guidelines. Molecule, dosage, route of administration and length of treatment were appropriate in 89,2% (315/353), 94,3% (333/353), 95,5% (337/353) and 24.4% (86/353) respectively. The inappropriateness rate of antibiotic initiation grew up a little between the 2 waves. Conclusion. A majority of the antibiotics prescribed for suspected bacterial respiratory tract infection could have been avoided. The respect of local guidelines was not optimal. Antimicrobial stewardship remains important to counter unnecessary and inappropriate antibiotic usage.