key: cord-0951766-okwg347r
authors: Tan, Sock Hoon; Ng, Tat Ming; Tay, Hui Lin; Yap, Min Yi; Heng, Shi Thong; Loo, Audrey Yong Xin; Teng, Christine B.; Lee, Tau Hong
title: A point prevalence survey to assess antibiotic prescribing in patients hospitalized with confirmed and suspected coronavirus disease 2019 (COVID-19)
date: 2020-12-08
journal: J Glob Antimicrob Resist
DOI: 10.1016/j.jgar.2020.11.025
sha: eb67d8d2a4185102e5aff6bf2ca0cda791cd841f
doc_id: 951766
cord_uid: okwg347r

nan

We describe a PPS of antibiotic use conducted on April 22, 2020, at 0800h in patients with suspected and confirmed COVID-19 at the National Centre for Infectious Diseases and Tan Tock Seng Hospital.

The definition of a suspected case was based on the presence of respiratory symptoms and relevant exposure history. The diagnosis is confirmed with a positive test for SARS-CoV-2, using laboratorybased polymerase chain reaction or serologic assays. [4] The objectives were to describe antibiotic utilization and evaluate antibiotic appropriateness. Trained AMS pharmacists collected antibiotic and clinical data in patients receiving at least one systemic antibiotic at 0800h. For each antibiotic, appropriateness was determined by considering treating physician's diagnosis and adjudicated by the AMS pharmacists and an AMS physician according to in-house and international guidelines. Quality indicators such as the reason for antibiotic prescription and indication of stop/review date were evaluated. Antivirals, antifungals and tuberculosis treatment were excluded. The study was approved by institutional review board (DSRB reference: 2020/00677).

There were 554 confirmed and 23 suspected COVID-19 patients. Eleven patients (1.9%) were in intensive care units (ICU). Overall, 6% (36/577) of the patients were on antibiotics and these were started at median of 7 days (inter-quartile rate (IQR), 4, 11) from symptom onset. Overall, coamoxiclav (26/51, 51%) was the most often-prescribed antibiotic and oral co-amoxiclav prescribing were often inappropriate (table 1) . Antibiotics were appropriate in 61% (31/51) of prescriptions.

Majority of the inappropriate prescriptions (18/20, 90%) were started for conditions deemed to be unrelated to bacterial infections. This resulted in 59 days of inappropriate antibiotic use.

Patients with appropriate antibiotic use had higher age-adjusted Charlson's co-morbidity scores (1 The low antibiotic prevalence was likely due to fewer severely ill cases with only 1.9% admitted to ICU.

Antibiotics were typically started in the second week of illness during the hyperinflammatory phase, making the differentiation between viral and secondary bacterial infection challenging. [5] Patients J o u r n a l P r e -p r o o f 

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