A point prevalence survey to assess antibiotic prescribing in patients hospitalized with confirmed and suspected coronavirus disease 2019 (COVID-19)

J Glob Antimicrob Resist. 2021 Mar:24:45-47. doi: 10.1016/j.jgar.2020.11.025. Epub 2020 Dec 8.


Background: Earlier studies have reported high antibiotic use in patients hospitalised for coronavirus disease 2019 (COVID-19), resulting in concerns of increasing antimicrobial resistance with increase antibiotic use in this pandemic. Point prevalence survey (PPS) can be a quick tool to provide antibiotic prescribing information to aid antimicrobial stewardship (AMS) activities.

Objectives: To describe antibiotic utilization and evaluate antibiotic appropriateness in COVID-19 patients using PPS.

Methods: Adapting Global-PPS on antimicrobial use, the survey was conducted in COVID-19 wards at 2 centres in Singapore on 22 April 2020 at 0800h. Patients on systemic antibiotics were included and evaluated for antibiotic appropriateness.

Results: Five hundred and seventy-seven patients were screened. Thirty-six (6.2%) patients were on antibiotics and which were started at median of 7 days (inter-quartile rate (IQR), 4, 11) from symptom onset. Fifty-one antibiotics were prescribed in these patients. Overall, co-amoxiclav (26/51, 51.0%) was the most often prescribed antibiotic. Thirty-one out of 51 (60.8%) antibiotic prescriptions were appropriate. Among 20 inappropriate prescriptions, 18 (90.0%) were initiated in patients with low likelihood of bacterial infections. Antibiotic prescriptions were more appropriate when reviewed by infectious diseases physicians (13/31 [41.9%] versus 2/20 [10.0%], p=0.015), and if reasons for use were stated in notes (31/31 [100.0%] versus 16/20 [80.0%], p=0.019).

Conclusions: Despite low prevalence of antibiotic use among confirmed and suspected COVID-19 patients at 2 centres in Singapore, there was significant proportion of inappropriate antibiotics use where bacterial infections were unlikely. AMS teams can tailor stewardship strategies using PPS results.

Keywords: Antibiotic; COVID-19; Coronavirus; Point prevalence survey; Stewardship.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis / statistics & numerical data
  • Antimicrobial Stewardship
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / microbiology
  • Bacterial Infections / virology
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / microbiology*
  • Drug Prescriptions / statistics & numerical data
  • Drug Resistance, Bacterial
  • Female
  • Hospitals / statistics & numerical data
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data
  • Prevalence
  • SARS-CoV-2 / isolation & purification
  • Singapore / epidemiology
  • Surveys and Questionnaires


  • Anti-Bacterial Agents