PLoS ONE (Jan 2024)

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

  • Robert Sinto,
  • Khie Chen Lie,
  • Siti Setiati,
  • Suhendro Suwarto,
  • Erni J Nelwan,
  • Mulya Rahma Karyanti,
  • Anis Karuniawati,
  • Dean Handimulya Djumaryo,
  • Ari Prayitno,
  • Sumariyono Sumariyono,
  • Mike Sharland,
  • Catrin E Moore,
  • Raph L Hamers,
  • Nicholas P J Day,
  • Direk Limmathurotsakul

DOI
https://doi.org/10.1371/journal.pone.0297405
Journal volume & issue
Vol. 19, no. 3
p. e0297405

Abstract

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BackgroundLittle 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.MethodsWe 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.ResultsOf 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]; pConclusionsRoutine 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.