Table 1.
Patient Characteristics and Bivariable Predictors of Early Empiric Antibacterial Therapy in Patients With Coronavirus Disease 2019 (COVID-19)
| Total (N = 1705) | Received Early Empiric Antibacterialsa (n = 965) | Did Not Receive Early Empiric Antibacterials (n = 740) | Rate Ratio (95% CI) | P | |
|---|---|---|---|---|---|
| Hospital characteristics | |||||
| Teaching hospital | 1560 (91.5) | 891 (92.3) | 669 (90.4) | 1.06 (.85–1.33) | .59 |
| Ownership | |||||
| Nonprofit | 1470 (86.2) | 779 (80.7) | 691 (93.4) | Ref | |
| For profit | 235 (13.8) | 186 (19.3) | 49 (6.6) | 1.46 (1.32–1.62) | <.001 |
| Bed size median (IQR) (rate ratio reported per 100-bed increase), beds | 391 (250–537) | 404 (250–537) | 391 (250–632) | .98 (.96–1.01) | .24 |
| Admission month | |||||
| March | 834 (48.9) | 556 (57.6) | 278 (37.6) | Ref | |
| April | 745 (43.7) | 348 (36.1) | 397 (53.6) | .73 (.65–.81) | <.001 |
| May | 111 (6.5) | 52 (5.4) | 59 (8.0) | .75 (.57–.98) | .04 |
| June | 15 (0.9) | 9 (0.9) | 6 (0.8) | .86 (.65–1.16) | .32 |
| Demographics | |||||
| Age, median (IQR) (rate ratio reported per 10-year increase), y | 64.7 (53.0–76.7) | 66.3 (54.5–78.1) | 62.8 (51.3–74.1) | 1.05 (1.02–1.09) | .001 |
| Women | 820 (48.1) | 471 (48.8) | 349 (47.2) | 1.02 (.94–1.10) | .65 |
| Race | |||||
| White | 732 (42.9) | 394 (40.8) | 338 (45.7) | Ref | |
| Black | 802 (47.0) | 473 (49.0) | 329 (44.5) | 1.05 (.90–1.21) | .56 |
| Other | 171 (10.0) | 98 (10.2) | 73 (9.9) | 1.06 (.92–1.22) | .40 |
| Comorbidities | |||||
| Body mass index, kg/m2 | 29.8 (25.5–35.9) | 29.4 (25.4–35.6) | 30.4 (25.7–36.7) | .99 (.98–1.00) | .06 |
| Charlson comorbidity score, median (IQR) | 1 (0–3) | 2 (0–3) | 1 (0–3) | 1.03 (1.01–1.05) | .003 |
| COPD | 200 (11.7) | 121 (12.5) | 79 (10.7) | 1.06 (.94–1.20) | .33 |
| Asthma | 215 (12.6) | 112 (11.6) | 103 (13.9) | .91 (.77–1.08) | .27 |
| Moderate or severe chronic kidney disease | 449 (26.3) | 275 (28.5) | 174 (23.5) | 1.12 (1.02–1.22) | .02 |
| On dialysis | 57 (3.3) | 30 (3.1) | 27 (3.6) | .94 (.77–1.15) | .57 |
| On immune-suppressive medications | 166 (9.7) | 98 (10.2) | 68 (9.2) | 1.08 (.97–1.20) | .16 |
| Admission from skilled nursing or subacute rehabilitation facility | 236 (13.8) | 155 (16.1) | 81 (10.9) | 1.18 (1.05–1.32) | .006 |
| Severity of illness | |||||
| Initial admission to intensive care unit | 185 (10.9) | 132 (13.7) | 53 (7.2) | 1.31 (1.20–1.44) | <.001 |
| Highest mode of respiratory support on day 1 or 2 of hospitalization | |||||
| No supplemental oxygen | 595 (34.9) | 278 (28.8) | 317 (42.8) | Ref | |
| Low-flow oxygen | 937 (55.0) | 554 (57.4) | 383 (51.8) | 1.24 (1.12–1.36) | <.001 |
| Heated high-flow nasal cannula | 44 (2.6) | 33 (3.4) | 11 (1.5) | 1.58 (1.35–1.85) | <.001 |
| Noninvasive positive-pressure ventilation | 13 (0.8) | 9 (0.9) | 4 (0.5) | 1.50 (1.16–1.95) | .002 |
| Mechanical ventilation | 116 (6.8) | 91 (9.4) | 25 (3.4) | 1.61 (1.35–1.92) | <.001 |
| Sepsis on day 1 or 2 of hospitalizationb | 1260 (73.9) | 748 (77.5) | 512 (69.2) | 1.23 (1.11–1.36) | <.001 |
| Severe sepsis on day 1 or 2 of hospitalizationb | 481 (28.2) | 319 (33.1) | 162 (21.9) | 1.25 (1.15–1.36) | <.001 |
| Septic shock on day 1 or 2 of hospitalizationb | 138 (8.1) | 101 (10.5) | 37 (5.0) | 1.35 (1.19–1.53) | <.001 |
| Signs/symptoms potentially indicating bacterial infection | |||||
| Highest white blood cell count on day 1 or 2 of hospitalization, median (IQR), 103/μL | 6.8 (5.2–9.2) | 7.0 (5.3–9.8) | 6.6 (4.9–8.6) | 1.01 (1.00–1.01) | .11 |
| Initial chest X-ray or chest CT was normal | 196 (11.5) | 74 (7.7) | 122 (16.5) | .66 (.57–.76) | <.001 |
| Initial chest X-ray or chest CT showed lobar infiltrate | 87 (5.1) | 63 (6.5) | 24 (3.2) | 1.29 (1.14–1.47) | <.001 |
| Initial procalcitonin value (N = 910c) | |||||
| 0–0.1 ng/mL | 288 (31.6) | 133 (26.7) | 155 (37.7) | Ref | |
| 0.1–0.25 ng/mL | 278 (30.5) | 144 (28.9) | 134 (32.6) | 1.15 (.97–1.35) | .11 |
| 0.25–0.5 ng/mL | 139 (15.3) | 76 (15.2) | 63 (15.3) | 1.22 (1.02–1.46) | .03 |
| >0.5 ng/mL | 205 (22.5) | 146 (29.3) | 59 (14.4) | 1.57 (1.39–1.77) | <.001 |
| Initial CRP (N = 999c), mg/dL | 18.8 (7.2–92.3) | 22.8 (8.9–107.7) | 15.2 (5.4–67.5) | 1.001 (1.000–1.002) | .001 |
| Sputum production | 223 (13.1) | 131 (13.6) | 92 (12.4) | 1.04 (.93–1.16) | .51 |
Data are presented as n (%) unless otherwise indicated; N = 1705. Missing data: 86 patients were missing body mass index, 23 patients were missing white blood cell count.
Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CT, computed tomography; IQR, interquartile range; Ref, reference.
aEmpiric antibacterial therapy was defined as any intravenous or oral antibacterial therapy prescribed on day 1 or 2 of hospitalization. Does not include patients who received azithromycin only.
bSepsis was defined as ≥2 of the following: temperature >38°C or <36°C, heart rate >90 beats/minute, respiratory rate >20 breaths/minute, and leukocyte count >12 × 109 cells/L or <4 × 109 cells/L or >10% immature bands. Severe sepsis was defined as sepsis plus evidence of organ dysfunction, defined as any of the following: systolic blood pressure <90 mm Hg (or initiation of vasopressors), lactate level >2 mmol/L, platelet count <100 × 109 cells/L, bilirubin level >2 mg/dL (without documentation of moderate or severe liver disease), creatinine level >2 mg/dL (without documentation of moderate or severe chronic kidney disease), or ventilatory support (ie, noninvasive positive-pressure ventilation or mechanical ventilation). Septic shock included any vasopressor requirement (vasopressors include angiotensin II, dobutamine, epinephrine, norepinephrine, phenylephrine, or vasopressin).
cNot missing at random; 910 patients had a procalcitonin test result and 999 had a CRP test result.