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

An Evaluation of the Impact of Increasing the Awareness of the WHO Access, Watch, and Reserve (AWaRe) Antibiotics Classification on Knowledge, Attitudes, and Hospital Antibiotic Prescribing Practices

The study aims to determine the effect of enhancing knowledge and awareness of the WHO Access, Watch, and Reserve (AWaRe) antibiotics classification on hospital clinical staff’s knowledge, attitudes and antibiotic prescribing practices. A pre-post-intervention study design was employed. The intervention was an educational activity that involved teaching physicians and pharmacists about the AWaRe classification and the risk of antibiotic resistance. A questionnaire was administered to clinical staff pre-and post-intervention. In the pre-interventional stage, 78.5% of participants stated they had not heard about the AWaRe classification of antibiotics. After receiving the intervention: the knowledge regarding the meaning and purpose of AWaRe classification of antibiotics increased from 39.1% to 75.4%; the percentage of participants who agreed with following the AWaRe classification of antibiotics in their practice increased from 21.7% to 58.5%; and the percentage of participants who agreed that AWaRe classification of antibiotics can suggest safe choices of antibiotics increased from 56.5% to 90.8%. Hospital antibiotic use of the Access group increased by 6.6% from pre- to post-intervention. The use of the Watch group and Reserve group decreased post-intervention by 1.7%, and 43.1%, respectively. This study showed important gaps in knowledge and attitudes towards AWaRe, highlighting the need for increasing the awareness of the AWaRe tool amongst healthcare practitioners to ensure rational use of antibiotics