Determinants of Antibiotic Use in SARS-CoV-2 Positive Patients during the COVID-19 Pandemic: A Retrospective Cohort Study Conducted in an Epidemic Treatment Center in Dakar (ETC)

Abstract

Introduction: COVID-19, like most viral respiratory diseases, can be associated with bacterial infections requiring antibiotic prescription. However, the prescription of antibiotics must be based on clinical and biological arguments, with clear recommendations. The aim of this study was to identify the factors associated with antibiotic prescription in patients hospitalized for COVID-19. Methodology: This was a retrospective cohort study including patients hospitalized for COVID-19 at the Epidemic Treatment Center of Fann Hospital from July 31, 2021 to March 31, 2022. Data were collected using a form and entered using Excel software. Analysis was performed using R software version 4.2.2. Factors associated with antibiotic prescribing were investigated using logistic regression.  Results: A total of 248 patients were included. The median age was 65 years [53, 73], with a male predominance (sex ratio M/F 2.25). Comorbidities were mainly hypertension (35.88%), cardiovascular disease (23.38%) and diabetes (21.77%). The main clinical signs were cough (60.17%), fever (40.41%) and dyspnea (22.56%). On imaging, a ground-glass appearance was found in the majority of cases (84.52%), with severe lung involvement in 31.25%. Almost all patients were treated with anticoagulation (96%) and corticosteroids (95%). Azithromycin was the most prescribed antibiotic (56.38%), and 77% of patients were on oxygen. Case fatality was 21%. In bivariate analysis, antibiotic prescription was associated with heart disease (81.25% vs. 47.83%, p=0.01), smoking (81.82% vs. 48.51%, p=0.03), signs of lung consolidation (55, 43% vs 34.43%, p=0.004), oxygen therapy (55.97% vs 36.84%, p=0.03) and the existence of a complication (62.24% vs 41.73%, p=0.002). In multivariate analysis, only smoking (OR: 5.78 [1.30-42]), fever (OR: 1.82 [1.04-3.24]) and signs of lung consolidation (OR: 2.52 [1.30-5.05]) were associated with antibiotic prescription. Conclusion: In patients infected with COVID-19, antibiotic prescription is indicated in those with clinically or biologically documented bacterial infection.