Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much?

Antibiotics

Gil Verschelden¹  Lucie Seyler¹  Sabine D. Allard¹  Jan Pierreux¹  Patrick Lacor¹  Thibault Depondt¹  Annelies Meuwissen¹  Johan Van Laethem¹  Stephanie C. M. Wuyts²  Denis Piérard³ 

[1] Department of Internal Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, UZ Brussel, 1090 Brussels, Belgium;Hospital Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium;Microbiology Department, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium;

关键词: antimicrobial stewardship;    antibiotics;    bacterial respiratory tract infection;    coinfection;    COVID-19;    superinfection;   

DOI  :  10.3390/antibiotics10121493

来源: DOAJ

【 摘 要 】

Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.

【 授权许可】

Unknown