Did Overuse of Antibiotics Drive Secondary Infection in COVID-19 Patients?

Since the start of the COVID-19 pandemic, infected persons have received unnecessary antibiotics. One obvious effect is that the erroneously prescribed antivirals do not aid in COVID-19 recovery. However, the overuse of antibiotics may also raise the risk of coinfection with dangerous, highly resistant pathogens.

One study compared antibiotic prescriptions in hospital patients with and without COVID-19 to determine whether the former had a higher rate of coinfection with Clostridioides difficile (C diff), multidrug-resistant (MDR) bacteria, and candida infections.

This single-center, retrospective cohort study was presented during a poster session at the recent IDWeek 2022 conference. It included 18757 adult patients who were hospitalized (during the pandemic) from March 1, 2020, to March 31, 3021.

Patients were categorized as either positive or negative COVID-19 infection status. The investigators quantified differences in antibiotic prescriptions by days of therapy per 1000 patient days. They compared rates of C diff infection, MDR-bacteria, and candida infections between the 2 cohorts.

During the year-long study, the investigators found that COVID-19-positive patients received 21.81% more antibiotics than the COVID-19-negative group. During the first month of the pandemic, March 2020, there was a 56.15% increase in antibiotics prescribed to COVID-19 patients.

The COVID-19 patients saw higher incidence of Candidemia (0.73% compared to 0.18% of COVID-19-negative patients) and decreased isolation of ESBL organisms (1.17% compared to 1.87% of the COVID-19-negative patients). Notably, the 2 cohorts had no statistically significant difference in rates of C diff, isolation of other MDR-pathogens, or Candida auris.

The investigators concluded that the patients hospitalized with COVID-19 had higher rates of candidemia, lower rates of ESBL infection, and were prescribed 21.81% more antibiotics than the COVID-19-negative patients. “The potential increase in antibiotic exposure could account for the increase in candidemia in patients with a history of COVID-19,” they wrote.

The study authors recommended further studies should explore the observed decrease in ESBL infections among COVID-19 patients, though they hypothesized this was due to the broad antibiotics these patients received targeting ESBL bacteria.