Antimicrobial prescribing and clinical outcomes in patients with COVID-19 infection: Experience of a single center in an upper middle-income country

OBJECTIVES: The aim of this study was to describe antimicrobial prescribing patterns in hospitalized adult patients with confirmed diagnosis of COVID-19 infection, and to determine the relationship between antimicrobial agent used and non-survival amongst the studied COVID-19 patients. METHODS: This is an observational, retrospective study. Specialty Clinic Hospital in Jordan is selected as the study setting for this conducted study. The study comprised of all hospitalized adult patients with confirmed diagnosis of COVID-19 infection who were admitted to the hospital between October 2020 and December 2020. FINDINGS: A total of 216 hospitalized patients with confirmed COVID-19 were included in the analysis. The majority of patients were prescribed antibiotic agents (n=149, 69.0%). Almost half of the patients have been prescribed antivirals agent (n=111, 51.4%). Survivals were significantly more likely to have been prescribed third generation cephalosporin (19.8% vs 3.4%, p=0.02). Non-survivals were significantly more likely to be older in age (mean age: 70.5 vs 62.7 years, p=0.009), have higher mean Charleston Comorbidity Index Score (3.7 vs 2.7, p=0.01), have at least one comorbidity (93.1% vs 71.1%, p=0.008), had shortness of breath at admission (72.4% vs 50.8%, p=0.023) and were admitted to the ICU during current admission (96.6% vs 18.7%, p<0.001) compared to survivors. Non-survivals were significantly more likely to had increased levels of WBC count (41.4% vs 19.7%; p=0.034), increased neutrophiles count (72.4% vs 39.4%; p=0.004) and higher mean C-reactive protein (167.2 vs 103.6; p=0.001) at admission. CONCLUSIONS: The results of this study demonstrated factors are associated with the non-survival, and additionally benchmarked the mortality rate, amongst the studied COVID 19 patients

Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains.

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy