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Antibiotics Overprescribed to Hospitalized Children with COVID-19

Although few cultures showed bacterial coinfections, many children were given antibiotics.

Worry about coinfection can drive the prescription of antibiotics to children who are ill enough to be hospitalized with COVID-19—but the rate of culture-confirmed bacterial coinfections is low, according to research presented at IDWeek 2022, held October 19 to 23 in Washington D.C.

Investigators conducted a single center retrospective cohort study evaluating all children who had symptomatic COVID-19 and were hospitalized in a pediatric intensive care unit at a tertiary care children’s hospital in the Southeastern United States from May 16, 2020, to February 11, 2022. Researchers reviewed medical records to collect demographic and clinical characteristics for each patient.

A total of 92 children were hospitalized for COVID-19 during the study period. The median age was 12.4 years and the median length of stay in the pediatric intensive care unit was 6 days. Nearly one-third of patients required mechanical ventilation and 5% died. Most of the children had at least 1 comorbidity, and just 1 child had been fully vaccinated.

Overall, 14% of the children (n=13) had bacterial growth from any specimen. Eight children had respiratory cultures that could indicate airway colonization; following exclusion, 5% (n=5) had urinary tract or bloodstream infections, with 2 bloodstream infections caused by drug-resistant organisms acquired in the hospital. Although a low number of bacterial infections were noted, 45% of children received antibiotics for 3 or more days. Furthermore, the days of antibiotic therapy had a wide rage, from 0 to 61 days.

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The researchers did note 2 limitations to their study: the single center retrospective design and that bacterial pneumonia may not be culture-confirmed. However, despite these limitations, “this work suggests that children with COVID-19 rarely have bacterial co-infections and are often prescribed unnecessary antibiotics.”

Reference

1. Banerjee R, Gillon J, Garguilo K, LeBlanc K. Antibiotic overuse among children with COVID-19 hospitalized in a pediatric intensive care unit. Presented at: IDWeek 2022; October 19-23, 2022; Washington, D.C. Poster 240.


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