286. Infectious Complications and Antimicrobial Utilization in Hospitalized Patients with COVID-19
Authors: Hunter Fraker J , Gandhi Vidhi , Duong Lan , Kumar Jai , Kumar Princy N , Timpone Joseph G 
Published: December 2021

Abstract

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 &lt; 0.001), vasopressor use (p &lt; 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 &lt; 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 &lt; 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.
Table 1. Demographics

Table 2. Antimicrobial Utilization in COVID-19 Patients

Conclusion
Although hospital-wide antimicrobial utilization had decreased during the COVID surge, COVID-19 patients with co-infections demonstrated a disproportionate use of antimicrobial agents as well as ICU resources. As MDRO infections were relatively common, antimicrobial stewardship should be prioritized in the COVID-19 population.

Disclosures
Lan Duong, Pharm.D., Astra Zeneca (Shareholder)Eli Lilly & Co. (Shareholder)Gilead Sciences, Inc. (Shareholder)Merck & Co. (Speaker’s Bureau)Moderna, Inc. (Shareholder)Novavax, Inc. (Shareholder)Sarepta Therapeutics (Shareholder)Thermo Fisher Scientific (Shareholder) Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)