Antibiotic Prescribing in Patients Presenting with COVID-19: A Closed-Loop Audit with a Targeted Educational Intervention in a South Australian Hospital

Sep 30, 2026

Antimicrobial resistance is a growing public health threat. Although community-acquired bacterial coinfection in adults hospitalized with COVID-19 is uncommon, antibiotics are often prescribed. This study evaluates antibiotic prescribing for suspected coinfection in adults admitted to a South Australian metropolitan referral hospital and assesses the effect of a targeted, locally developed educational intervention. A closed-loop retrospective audit compared prescribing before and after education, using adherence to predefined consensus criteria and appropriate statistical testing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

1. Introduction

2. Materials and Methods

Article Antibiotic Prescribing in Patients Presenting with COVID-19: A Closed-Loop Audit with a Targeted Educational Intervention in a South Australian Hospital Robert Yarham 1,2, *, Colette Dignam 1,2 and Dylan Toh 2 Academic Editors: Francisco Guillen-Grima and Emanuele Pontali Received: 17 November 2025 Revised: 23 December 2025 Accepted: 25 December 2025 Published: 28 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Health and Medical Sciences, University of Adelaide, Corner of George Street and North Terrace, Adelaide, SA 5000, Australia; [colette.dignam@sa.gov.au](colette.dignam@sa.gov.au) 2 General Medicine Department, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia; [dylan.toh@sa.gov.au](dylan.toh@sa.gov.au) * Correspondence: [robert.yarham@adelaide.edu.au or](robert.yarham@adelaide.edu.au or) [robert.yarham@sa.gov.au](robert.yarham@sa.gov.au) Abstract Background/Objectives: Antimicrobial resistance is an escalating public health threat. Despite the low prevalence of community-acquired bacterial coinfection (CABC) in patients presenting with COVID-19, antibiotics are frequently prescribed. We evaluated antibiotic prescribing for suspected CABC in adults admitted with COVID-19 to a metropolitan referral hospital in South Australia and the impact of a targeted, locally developed educational intervention. Methods: We conducted a closed-loop retrospective audit of consecutive adult COVID-19 non-intensive care unit admissions to the General Medicine Unit over a six-month period (5 February–6 August 2024), totalling 126 episodes after exclusions. Antibiotic prescribing rates were compared before and after implementation of targeted education to admitting clinicians. This was delivered via guideline-focused presentationsat unit meetings, emails and posters in key clinical areas detailing the consensus recommendation, and brief electronic reminder messages. Prescribing appropriateness was inferred from adherence to the consensus recommendation, which included predefined criteria relating to total leukocyte count, neutrophilia, and radiological findings. Statistical comparisons were performed using appropriate statistical tests for categorical and continuous variables. Results: Following the intervention, antibiotic prescribing decreased from 26% to 22% of admissions (p = 0.57), and prescribing among patients who did not meet the specified criteria fell from 16% to 6%(p = 0.30) . The proportion of prescriptions meeting the consensus criteria increased from 62% to 80%(p = 0.43) . Conclusions: Baseline antibiotic use was substantially lower than commonly published rates but still exceeded expected CABC prevalence. Targeted education and simple, locally adaptable guidance may support improved antimicrobial stewardship in COVID-19 admissions. Keywords: COVID-19; coronavirus; bacterial coinfection; pneumonia; antimicrobial stewardship; quality improvement; education intervention; antibiotic prescribing 1. Introduction Antimicrobial stewardship is a critical component in preventing the emergence and spread of antimicrobial resistance (AMR) and multidrug-resistant pathogens [1,2] . Antimicrobial resistance is associated with increased morbidity and mortality—over 700,000 deaths globally per year [1]—as well as prolonged hospitalisation, more frequent and severe treatment complications, and substantially higher healthcare resource utilisation [1–3] . Overuse of antibiotics is a key driver of AMR, increasing selection pressure on bacteria and promoting the dominance of resistant strains [3,4] . Coronavirus disease 2019 (COVID-19) represents an important setting of antibiotic overuse. Numerous studies have shown that the rate of community-acquired bacterial coinfection (CABC) in adult patients admitte

FAQs

What problem does the study address regarding COVID-19 admissions?

It addresses frequent antibiotic prescribing despite low community-acquired bacterial coinfection rates in adults presenting with COVID-19, which can contribute to antimicrobial resistance.

How was the audit conducted and what period was studied?

A closed-loop retrospective audit reviewed consecutive adult COVID-19 non-intensive care unit admissions to the General Medicine Unit over six months (5 February–6 August 2024), totaling 126 episodes after exclusions.

How did the targeted educational intervention affect prescribing?

After the intervention, overall antibiotic prescribing decreased from 26% to 22%, and prescribing among patients not meeting predefined criteria fell from 16% to 6%. The proportion meeting consensus criteria increased from 62% to 80%.

Sep 30, 2026

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