Search

Introduction Antibiotic usage for COVID-19 patients was uncertain in the early phase of the pandemic. Objectives: To determine the prevalence of antibiotic usage and factors affecting antibiotic usage in COVID-19 patients. Methodology This is a cross-sectional study which reviewed medical records of COVID-19 Malaysian patients aged 12 and above who were admitted to all COVID-19 hospitals in from February to April 2020. Binary logistic regression analysis was performed to determine factors associated with antibiotic use in COVID-19 patients. Results Of 4043 cases, the majority of the patients were male (65.0%), non-smoker (87.6%), and had at least one comorbid (37.0%) with a median age of 38 years (IQR: 38). The prevalence of antibiotic usage was 16.5% with 4.7% of them prescribed with two or more types. The most frequent antibiotic prescribed were Co-Amoxiclav (10.6%) followed by Ceftriaxone (3.4%), Piperacillin/Tazobactam (3.8%), Azithromycin (2.3%), and Meropenem (2.0%). Higher odds of antibiotic usage were seen in male patients who had comorbidities, clinical severity of stage two to five, out-of-range inflammatory blood parameters (white blood cells, neutrophils, lymphocytes and C-reactive protein), use of corticosteroid and admission to the intensive care unit. Conclusion The prevalence of antibiotic usage at the early phase of COVID-19 pandemic was 16.5%, which is relatively low compared to other countries (58 to 71%). Significant factors influencing the odds of antibiotic usage were consistent with findings from other studies. This observation showed that clinicians rationalized the antibiotic usage based on clinical assessment, supported by relevant laboratory parameters. [Disclaimer: Abstract text might vary slightly from what is displayed in the e-poster], This poster was submitted to the 14th National Conference for Clinical Research (NCCR) in August 18-20, 2021. https://nccrconference.com.my/

IntroductionCoronavirus Disease 2019 (COVID-19) patients presented to the hospital with various clinical patterns leading to different clinical progression and outcome. This study aimed to describe the proportion of non-severe COVID-19 patients who deteriorated after hospitalization and their clinical characteristics. MethodologyCross-sectional study was conducted on adult cases of Covid-19 presented with severity stage 3 and below at a tertiary public hospital in Perak from February to July 2020. Data were collected from medical records. Deterioration is defined as clinical progression to severe stages after admission. All analysis were performed using SPSS version 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0, Armonk, NY: IBM Corp). P-value of ResultsThe study population included 178 hospitalized COVID-19 cases with laboratory confirmation by reverse-transcription polymerase chain reaction (RT-PCR). Seventeen percent (31/178) of COVID-19 cases deteriorated after admission at median day 7 (IQR: 6,9) of illness (Figure 1). Sociodemographic characteristics between deteriorated and non-deteriorated groups were shown in Table 1. More than half of those who deteriorated had hypertension (13[59.1%]) and diabetes mellitus (12[54.5%]). Those who deteriorated had mean white cell count of 7.2x109 /L (SD: 2.2), median neutrophil/lymphocyte ratio of 2.55 (IQR: 1.77,3.59), median C-reactive protein (CRP) of 5.50mg/L (IQR: 2.10,18.20) and mean blood sugar of 12.57mmol (SD: 8.46). Median creatinine was 88.5 mmol/L (IQR: 77.0, 103.5) and median aspartate aminotransferase (AST) was 37.0 U/L (IQR: 27.0, 41.0). Table 2 showed chest X-ray abnormalities upon admission. Aged patients with comorbidities, smoking status, high CRP, high creatinine level, high AST level and interstitial opacities involving lower zone were more likely to deteriorate after hospitalization (p Discussion and ConclusionAge and comorbidities had the propensity to deteriorate further, similar to findings seen in other early studies. 1 As concluded in a meta-analysis, this study also showed smoking status was not necessary lead to disease deterioration. 2 Elevated creatinine, AST and CRP were indicators of organ involvement that drives patient deterioration further. This was supported by studies on severity predictors and survival abroad. Lower zone involvement on the chest radiograph was the most common finding noted, consistent with the findings of ARDS. Risk profiling patients who may deteriorate using clinical characteristics can help clinicians intensify clinical monitoring and trigger possible early interventions to reduce associated mortality risks. &nbsp