285. Outcomes and Antibiotic Use in Patients with COVID-19 Admitted to an Intensive Care Unit

Abstract Background Studies have shown the proportion of critically ill patients with COVID-19 receiving empiric antibiotics (ABX) greatly exceeds those with culture-proven bacterial co-infections. However, the benefits of continuing ABX in culture-negative (CxN) cases is unknown; this practice may increase the risks associated with ABX overuse. The purpose of this study was to evaluate outcomes and antibiotic use (AU) in intensive care unit (ICU) patients with COVID-19 based on culture results. Methods This was a multicenter, retrospective cohort study evaluating adults in an ICU for the first episode of ABX initiated following a confirmed COVID-19 diagnosis between September to December 2020. Blood and/or respiratory cultures must have been obtained within 24 hours (h) of ABX initiation. Patients were categorized into three groups: 1) CxN, ABX discontinued ≤ 72 h, 2) CxN, ABX continued > 72 h, or 3) Culture-positive (CxP). Data on AU was obtained from electronic medication administration records. The primary outcome was clinical success, defined as being discharged alive or > 2-point decrease in the World Health Organization Clinical Progression Scale score from day of ABX initiation to day 30. Results A total of 65 patients were included with 35.4% being CxP. ABX were discontinued ≤ 72 h in 23.8% of CxN patients. Methicillin-susceptible Staphylococcus aureus was the most common organism in 52.2% of CxP patients (66.7% respiratory; 16.7% blood; 16.7% both). Anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal antibiotics were the most prescribed for the initial regimen (Table 1). ABX de-escalation occurred in 58.5% of patients. Initial ABX duration was significantly longer in the CxP group (P < 0.01). No significant difference in clinical success was observed (Table 2). Although not significantly different, the highest rate of adverse events occurred in the CxN and ABX continued > 72 h group (40.6%). Table 1. Antibiotic Use in ICU Patients with COVID-19 Table 2. Clinical Outcomes and Adverse Events in ICU Patients with COVID-19 Conclusion In ICU patients with COVID-19, empiric broad-spectrum ABX are often overutilized with an inertia to de-escalate despite negative culture results, potentially increasing the risk of adverse events. This remains an important area for focused antimicrobial stewardship efforts to mitigate the development of multidrug resistance. Disclosures Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support)


Background.
Studies have shown the proportion of critically ill patients with COVID-19 receiving empiric antibiotics (ABX) greatly exceeds those with culture-proven bacterial co-infections. However, the benefits of continuing ABX in culture-negative (CxN) cases is unknown; this practice may increase the risks associated with ABX overuse. The purpose of this study was to evaluate outcomes and antibiotic use (AU) in intensive care unit (ICU) patients with COVID-19 based on culture results.
Methods. This was a multicenter, retrospective cohort study evaluating adults in an ICU for the first episode of ABX initiated following a confirmed COVID-19 diagnosis between September to December 2020. Blood and/or respiratory cultures must have been obtained within 24 hours (h) of ABX initiation. Patients were categorized into three groups: 1) CxN, ABX discontinued ≤ 72 h, 2) CxN, ABX continued > 72 h, or 3) Culturepositive (CxP). Data on AU was obtained from electronic medication administration records. The primary outcome was clinical success, defined as being discharged alive or > 2-point decrease in the World Health Organization Clinical Progression Scale score from day of ABX initiation to day 30.
Results. A total of 65 patients were included with 35.4% being CxP. ABX were discontinued ≤ 72 h in 23.8% of CxN patients. Methicillin-susceptible Staphylococcus aureus was the most common organism in 52.2% of CxP patients (66.7% respiratory; 16.7% blood; 16.7% both). Anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal antibiotics were the most prescribed for the initial regimen (Table 1). ABX de-escalation occurred in 58.5% of patients. Initial ABX duration was significantly longer in the CxP group (P < 0.01). No significant difference in clinical success was observed (Table 2). Although not significantly different, the highest rate of adverse events occurred in the CxN and ABX continued > 72 h group (40.6%).  Conclusion. In ICU patients with COVID-19, empiric broad-spectrum ABX are often overutilized with an inertia to de-escalate despite negative culture results, potentially increasing the risk of adverse events. This remains an important area for focused antimicrobial stewardship efforts to mitigate the development of multidrug resistance.
Disclosures Background. Hospitalized patients with COVID-19 have created increased demands on health care infrastructure and resources. Bacterial and fungal infections have been reported and have increased the need for antimicrobial utilization. We performed a retrospective chart review to characterize bacterial infections and antibiotic utilization during the COVID-19 surge at our tertiary care center.
Methods. All patients diagnosed with COVID-19 using SARS-CoV-2 PCR admitted to MedStar Georgetown University Hospital from 01Mar2020 through 31Aug2020 were included in the analysis. Data was collected on hospital-wide antimicrobial utilization [mean days of therapy per 1000-patient-days (DOT)] during the 6-month surge and was compared to antimicrobial utilization during a 6-month period that preceded the COVID-19 surge. Clinical and microbiological data and patient outcomes were also collected and analyzed.
Results. A total of 238 patients met eligibility criteria during the observation period, of which 25.6% (n = 61) developed a bacterial, fungal, or viral co-infection. Culture-positive bacterial complications were seen in 21.8% (n = 52) with 32.8% (n = 20) having a multidrug resistant organism (MDRO). There was a statistically significant difference between COVID-19 patients with co-infection and those without for intubation (p < 0.001), vasopressor use (p < 0.001), and renal replacement therapy (p = 0.001). COVID-19 patients with co-infections had a longer mean length of stay (21.9 days vs 13.5 days, p < 0.001) and greater mortality (32.8% vs 20.6%, p = 0.006) compared to those without a co-infection, respectively. Mean antimicrobial utilization for the entire hospital population was 790.6 DOT during the COVID surge compared to 928.7 DOT during a 6-month period preceding the COVID surge (p < 0.001). For all COVID-19 patients, antimicrobial utilization was 846.9 DOT; however, this increased to 1236.4 DOT for COVID-19 patients with co-infections.