54 - Microbiologic Characterization and Antibacterial Use in Hospitalized Adults with covid-19 Infection

Background: Coronavirus disease 2019 (CoVID-19) admissions, oft complicated by an uncertain trajectory, lent to treatment influenced by supposition.  Respiratory bacterial co-infection frequently was invoked.  The purpose of this study was to determine the respiratory pathogen distribution and antibiotic prescribing patterns in hospitalized patients with CoVID-19.

Methods: Patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ICD-10 code and/or positive polymerase chain reaction (PCR) hospitalized between March 1 and May 31, 2020 were included.  Antibiotic utilization (patient days of therapy-pDOT) was collected for the institution during this period and two years prior.  Respiratory microbiologic cultures were reviewed to examine the frequency of co-infection on presentation, categorized as within 3 calendar days from admission or afterward. The relationship of antibiotic utilization to positive cultures was also categorized.

Results: Of the 7,969 encounters, 829 were ICD-10 coded and/or confirmed SARS-CoV-2 PCR positive and 196 (23.6%) had positive respiratory cultures.  89.8% of patients had endotracheal samples, the rest were isolated from sputum or bronchoalveolar lavage (17.4% and 6.6%, respectively). Patients were more likely to isolate commensal respiratory flora (108 versus 78 patients within the first 3 days of presentation. Notable isolates such as Staphylococcus aureus and Pseudomonas aeruginosa, were more often isolated after 3 days of hospitalization.  While the CoVID-19 average hospital census was only 14.7% of the total, antibiotic utilization, (pDOT/1000) was 2.3 times higher, 831.9 versus 368.3 across the institution. During similar periods in 2018 and 2019, days of therapy overall were lower.  For CoVID-19 infected patients, the frequency of antibiotic initiation was 73.2%.  The length of therapy was on average 8 days with a high rate of observed restarts.Table 1: Patient characteristics for CoVID-19 infected patients admitted during March 1 to May 31, 2020
Figure 1: Positive respiratory pathogen culture results for CoVID-19 encounters (March 1-May 31, 2020)
Table 2: Prevalence and select types of antibiotics administered to CoVID-19 patients. (March 1-May 31, 2020)


Conclusion: Bacterial co-infection in an acute viral process is generally low.  In this examination of CoVID-19 infected patients, the rate of any positive respiratory culture was 23.6%. A disproportionate effect on the volume of antibiotics and total days of therapy prompted an interest in early stewardship efforts and education.Table 3: Antibiotic consumption (patient days of therapy) for CoVID-19 encounters (March 1-May 31, 2020) compared to total consumption during identical time periods in 2018, 2019, and 2020

Presenting Author(s)

• 

  Ryan W. Chapin, PharmD, BCIDP

  Infectious Diseases Pharmacist
  Beth Israel Deaconess Medical Center
  Boston, MA

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

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Co-Author(s)

• NM

  Nicholas J. Mercuro, PharmD

  Infectious Diseases Pharmacist
  Beth Israel Deaconess Medical Center
  Boston, Massachusetts

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

  Yen Christina, MD

  Infectious Diseases Fellow
  Beth Israel Deaconess Medical Center
  Boston, Massachusetts

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

  Catherine Li, PharmD

  Pharmacist
  Beth Israel Deaconess Medical Center

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

  Gold Howard, MD

  Medical Director- Antimicrobial Stewardship
  Beth Israel Deaconess Medical Center
  Boston, Massachusetts

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

  Christopher McCoy, PharmD, BCIDP

  Associate Director, Antimicrobial Stewardship
  Beth Israel Deaconess Medical Center
  Boston, Massachusetts

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