74 - Empiric Antibiotic Therapy and Community-onset Bacterial Co-infection in Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study

Background: Antibiotic therapy has no known benefit against COVID-19, but is often initiated out of concern for concomitant bacterial infection. We sought to determine how common early empiric antibiotic therapy and community-onset bacterial co-infections are in hospitalized patients with COVID-19.

Methods: In this multi-center cohort study of hospitalized patients with COVID-19 discharged from 32 Michigan hospitals during the COVID-19 Michigan surge, we describe the use of early empiric antibiotic therapy (within the first two days) and prevalence of community-onset bacterial co-infection. Additionally, we assessed patient and hospital predictors of early empiric antibiotic using poison generalized estimating equation models.

Results: Between 3/10/2020 and 5/10/2020, data were collected on 951 COVID-19 PCR positive patients. Patient characteristics are described in Table 1. Nearly two thirds (62.4%, 593/951) of COVID-19 positive patients were prescribed early empiric antibiotic therapy, most of which (66.2%, 393/593) was directed at community-acquired pathogens. Across hospitals, the proportion of COVID-19 patients prescribed early empiric antibiotics varied from 40% to 90% (Figure 1). On multivariable analysis, patients were more likely to receive early empiric antibiotic therapy if they were older (adjusted rate ratio [ARR]: 1.01 [1.00-1.01] per year), required respiratory support (e.g., low flow oxygen, ARR: 1.16 [1.04-1.29]), had signs of a bacterial infection (e.g., lobar infiltrate, ARR: 1.17 [1.02-1.34]), or were admitted to a for-profit hospital (ARR: 1.27 [1.11-1.45]); patients admitted later were less likely to receive empiric antibiotics (April vs. March, ARR: 0.72 [0.62-0.84], Table 2). Community-onset bacterial co-infections were identified in 4.5% (43/951) of COVID-19 positive patients (2.4% [23/951] positive blood culture; 1.9% [18/951] positive respiratory culture).Table 1. Bivariable Predictors of Early Empiric Antibiotic Therapy in Patients with COVID-19, N=951
Table 2. Multivariable Predictors of Early Empiric Antibiotic Therapy in Patients with COVID-19, N=951
Figure 1. Early Empiric Antibiotic Treatment for COVID-19 Positive Patients, by Hospital (N=26)


Conclusion: Despite low prevalence of community-onset bacterial co-infections, patients hospitalized with COVID-19 often received early empiric antibiotic therapy. Given the potential harms from unnecessary antibiotic use, including additional personal protective equipment to administer antibiotics, judicious antibiotic use is key in hospitalized patients with COVID-19.

Presenting Author(s)

• 

  Valerie Vaughn, MD, MSc

  Director of Hospital Medicine Research
  University of Utah School of Medicine
  Salt Lake City, UT

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• 

  Tejal N. Gandhi, MD

  Clinical Associate Professor of Internal Medicine, Division of Infectious Diseases Medical Director Antimicrobial Stewardship Program
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: Blue Cross Blue Shield of Michigan : Grant/Research Support (Status: Ongoing)
• LP

  Lindsay A. Petty, MD

  Infectious Disease Assistant Professor
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• PP

  Payal K. Patel, MD, MPH

  Dr.
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HP

  Hallie Prescott, MD, MSc

  Dr.
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Anurag N. Malani, MD, FIDSA, FSHEA

  Medical Director, Infection Prevention & Antimicrobial Stewardship Programs
  St. Joseph Mercy Health System, Ann Arbor
  Ann Arbor, MI

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• DR

  David Ratz, MS

  Statistician
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EM

  Elizabeth McLaughlin, BSN, MS

  Project Manager of HMS
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Vineet Chopra, MD, MSc

  Chief, Division of Hospital Medicine
  Michigan Medicine
  Ann Arbor, Michigan

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SF

  Scott A. Flanders, MD

  Professor of Medicine, Chief Clinical Strategy Officer
  University of Michigan
  Ann Arbor, Michigan

  Disclosure: Agency for Healthcare Research and Quality (Research Grant or Support)Blue Cross Blue Shield of Michigan (Research Grant or Support)