Diagnostic and antibiotic use practices among COVID-19 and non-COVID-19 patients in the Indonesian National Referral Hospital

PLoS One. 2024 Mar 7;19(3):e0297405. doi: 10.1371/journal.pone.0297405. eCollection 2024.

Abstract

Background: Little is known about diagnostic and antibiotic use practices in low and middle-income countries (LMICs) before and during COVID-19 pandemic. This information is crucial for monitoring and evaluation of diagnostic and antimicrobial stewardships in healthcare facilities.

Methods: We linked and analyzed routine databases of hospital admission, microbiology laboratory and drug dispensing of Indonesian National Referral Hospital from 2019 to 2020. Patients were classified as COVID-19 cases if their SARS-CoV-2 RT-PCR result were positive. Blood culture (BC) practices and time to discontinuation of parenteral antibiotics among inpatients who received a parenteral antibiotic for at least four consecutive days were used to assess diagnostic and antibiotic use practices, respectively. Fine and Grey subdistribution hazard model was used.

Results: Of 1,311 COVID-19 and 58,917 non-COVID-19 inpatients, 333 (25.4%) and 18,837 (32.0%) received a parenteral antibiotic for at least four consecutive days. Proportion of patients having BC taken within ±1 calendar day of parenteral antibiotics being started was higher in COVID-19 than in non-COVID-19 patients (21.0% [70/333] vs. 18.7% [3,529/18,837]; p<0.001). Cumulative incidence of having a BC taken within 28 days was higher in COVID-19 than in non-COVID-19 patients (44.7% [149/333] vs. 33.2% [6,254/18,837]; adjusted subdistribution-hazard ratio [aSHR] 1.71, 95% confidence interval [CI] 1.47-1.99, p<0.001). The median time to discontinuation of parenteral antibiotics was longer in COVID-19 than in non-COVID-19 patients (13 days vs. 8 days; aSHR 0.73, 95%Cl 0.65-0.83, p<0.001).

Conclusions: Routine electronic data could be used to inform diagnostic and antibiotic use practices in LMICs. In Indonesia, the proportion of timely blood culture is low in both COVID-19 and non-COVID-19 patients, and duration of parenteral antibiotics is longer in COVID-19 patients. Improving diagnostic and antimicrobial stewardship is critically needed.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • COVID-19 Testing
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • Hospitals
  • Humans
  • Indonesia / epidemiology
  • Pandemics
  • SARS-CoV-2

Substances

  • Anti-Bacterial Agents

Grants and funding

This study is funded by Research Fund of Division of Tropical and Infectious Diseases, Department of Internal Medicine, Cipto Mangunkusumo National Hospital and in part by the Wellcome Trust [220211]. RS is funded by Indonesian Education Scholarship (Beasiswa Pendidikan Indonesia [BPI]) [202101182688] from the Ministry of Education, Culture, Research, and Technology Republic of Indonesia: Directorate General of Higher Education, Research, and Technology (Direktorat Jenderal Pendidikan Tinggi, Riset dan Teknologi Kementerian Pendidikan, Kebudayaan, Riset dan Teknologi Republik Indonesia) and Indonesian Endowment Fund for Education (Lembaga Pengelola Dana Pendidikan [LPDP]). DL is supported by the Wellcome Trust. For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The funders of the investigators and study had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript. The corresponding author had the final responsibility for the decision to submit for publication.