{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:27:07Z","timestamp":1791664027887,"version":"4.3.4"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T00:00:00Z","timestamp":1654128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background and Objectives: Empirical antibiotic prescribing in patients with coronavirus disease 2019 (COVID-19) has been common even though bacterial coinfections are infrequent. The overuse of antibacterial agents may accelerate the antibiotic resistance crisis. We aimed to evaluate factors predicting empirical antibiotic prescribing to adult COVID-19 inpatients over 2 years (March 2020\u2013February 2021) in Mexico. Materials and Methods: A cross-sectional analysis of a nationwide cohort study was conducted. Hospitalized adults due to laboratory-confirmed COVID-19 were included (n = 214,171). Odds ratios (OR) and 95% confidence intervals (CI), computed by using logistic regression models, were used to evaluate factors predicting empirical antibiotic prescribing. Results: The overall frequency of antibiotic usage was 25.3%. In multiple analysis, the highest risk of antibiotic prescription was documented among patients with pneumonia at hospital admission (OR = 2.20, 95% CI 2.16\u20132.25). Male patients, those with chronic comorbidities (namely obesity and chronic kidney disease) and longer interval days from symptoms onset to healthcare seeking, were also more likely to receive these drugs. We also documented that, per each elapsed week during the study period, the odds of receiving antibiotic therapy decreased by about 2% (OR = 0.98, 95% CI 0.97\u20130.99). Conclusion: Our study identified COVID-19 populations at increased risk of receiving empirical antibiotic therapy during the first two years of the pandemic.<\/jats:p>","DOI":"10.3390\/antibiotics11060764","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T11:05:02Z","timestamp":1654167902000},"page":"764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Empirical Antibiotic Prescribing in Adult COVID-19 Inpatients over Two Years in Mexico"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1118-498X","authenticated-orcid":false,"given":"Efr\u00e9n","family":"Murillo-Zamora","sequence":"first","affiliation":[{"name":"Departamento de Epidemiolog\u00eda, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Av. Javier Mina 301, Col. Centro, Colima 28000, Mexico"},{"name":"Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las V\u00edboras, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8146-5667","authenticated-orcid":false,"given":"X\u00f3chitl","family":"Trujillo","sequence":"additional","affiliation":[{"name":"Centro Universitario de Investigaciones Biom\u00e9dicas, Universidad de Colima, Av. 25 de julio 965, Col. Villas San Sebasti\u00e1n 28045, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8515-0777","authenticated-orcid":false,"given":"Miguel","family":"Huerta","sequence":"additional","affiliation":[{"name":"Centro Universitario de Investigaciones Biom\u00e9dicas, Universidad de Colima, Av. 25 de julio 965, Col. Villas San Sebasti\u00e1n 28045, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9614-4946","authenticated-orcid":false,"given":"Oliver","family":"Mendoza-Cano","sequence":"additional","affiliation":[{"name":"Facultad de Ingenier\u00eda Civil, Universidad de Colima, km. 9 carretera Colima-Coquimatl\u00e1n, Coquimatl\u00e1n 28400, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Guzm\u00e1n-Esquivel","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las V\u00edboras, Colima 28040, Mexico"},{"name":"Unidad de Investigaci\u00f3n en Epidemiolog\u00eda Cl\u00ednica, Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Av. Lapisl\u00e1zuli No. 250, Col. El Haya, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Alejandro","family":"Guzm\u00e1n-Sol\u00f3rzano","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las V\u00edboras, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Regina","family":"Ochoa-Castro","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las V\u00edboras, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan Gabriel","family":"Ortega-Mac\u00edas","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las V\u00edboras, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Lizeth","family":"Zepeda-Anaya","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las V\u00edboras, Colima 28040, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Ruiz-Montes de Oca","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Plantel Guadalajara, Universidad Cuauht\u00e9moc, Av. del Baj\u00edo No. 5901, Col. Del Baj\u00edo, Zapopan 45019, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2883-4619","authenticated-orcid":false,"given":"M\u00f3nica","family":"R\u00edos-Silva","sequence":"additional","affiliation":[{"name":"Centro Universitario de Investigaciones Biom\u00e9dicas, CONACyT-Universidad de Colima, Av. 25 de julio 965, Col. Villas San Sebasti\u00e1n, Colima 28045, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6689-2783","authenticated-orcid":false,"given":"Agustin","family":"Lugo-Radillo","sequence":"additional","affiliation":[{"name":"CONACYT\u2014Faculty of Medicine and Surgery, Universidad Aut\u00f3noma Benito Ju\u00e1rez de Oaxaca, Col. Ex Hacienda de Aguilera S\/N, San Felipe del Agua, Oaxaca 68020, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pettit, N.N., Nguyen, C.T., Lew, A.K., Bhagat, P.H., Nelson, A., Olson, G., and Pagkas-Bather, J. (2021). Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06219-z"},{"key":"ref_2","unstructured":"Government of Mexico (2022, April 08). COVID-19 in Mexico (Updated on 8 April 2022), (In Spanish)."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bendala Estrada, A.D., Calder\u00f3n Parra, J., Fern\u00e1ndez Carracedo, E., Mui\u00f1o M\u00edguez, A., Ramos Mart\u00ednez, A., Mu\u00f1ez Rubio, E., and N\u00fa\u00f1ez-Cort\u00e9s, J.M. (2021). Inadequate use of antibiotics in the COVID-19 era: Effectiveness of antibiotic therapy. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06821-1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1056\/NEJMc2010419","article-title":"Clinical Characteristics of COVID-19 in New York City","volume":"382","author":"Goyal","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Jabczyk, M., Nowak, J., Hudzik, B., and Zubelewicz-Szkodzi\u0144ska, B. (2021). Microbiota and Its Impact on the Immune System in COVID-19\u2014A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194537"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3106","DOI":"10.1038\/s41598-022-07142-2","article-title":"Correlation between antibiotic consumption and the occurrence of multidrug-resistant organisms in a Malaysian tertiary hospital: A 3-year observational study","volume":"12","author":"Tan","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e0134121","DOI":"10.1128\/AAC.01341-21","article-title":"Antibiotic Use and Bacterial Infection among Inpatients in the First Wave of COVID-19: A Retrospective Cohort Study of 64,691 Patients","volume":"65","author":"Baghdadi","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_9","first-page":"42","article-title":"Antimicrobial resistance and antibiotic consumption in Mexican hospitals","volume":"62","year":"2020","journal-title":"Salud Publica Mex."},{"key":"ref_10","unstructured":"General Directorate of Epidemiology of the Government of Mexico (2022, April 01). Standardized Guideline for Epidemiological and Laboratory Surveillance of Viral Respiratory Disease (Updated on January 2022), (In Spanish)."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Murillo-Zamora, E., Trujillo, X., Huerta, M., R\u00edos-Silva, M., and Mendoza-Cano, O. (2020). Male gender and kidney illness are associated with an increased risk of severe laboratory-confirmed coronavirus disease. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05408-6"},{"key":"ref_12","unstructured":"Government of Mexico (2022, April 01). Clinical Guideline for the Treatment of COVID-19 in Mexico: Inter-Institutional Consensus (Updated on August 2021). (In Spanish)."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e533","DOI":"10.1093\/cid\/ciaa1239","article-title":"Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study","volume":"72","author":"Vaughn","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/23744235.2020.1839672","article-title":"Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: Results from a multicentre retrospective cohort study in The Netherlands","volume":"53","author":"Karami","year":"2021","journal-title":"Infect. Dis. (Lond.)"},{"key":"ref_15","unstructured":"Mexican Social Security Institute (2022, February 06). Press release (19 January 2022): With 79 Years of Existence, the IMSS Has Demonstrated Its Ability to Respond to Natural Disasters and Health Crises, (In Spanish)."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"113882","DOI":"10.1016\/j.ijheh.2021.113882","article-title":"Alterations of fecal antibiotic resistome in COVID-19 patients after empirical antibiotic exposure","volume":"240","author":"Kang","year":"2022","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1093\/cid\/ciaa576","article-title":"Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis","volume":"71","author":"Zhang","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.12688\/f1000research.26186.1","article-title":"Predictors of COVID-19 severity: A systematic review and meta-analysis","volume":"9","author":"Mudatsir","year":"2020","journal-title":"F1000Research"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.cmi.2020.08.022","article-title":"Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: A systematic review and meta-analysis","volume":"27","author":"Fiolet","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s40264-020-00976-7","article-title":"Azithromycin in COVID-19 Patients: Pharmacological Mechanism, Clinical Evidence and Prescribing Guidelines","volume":"43","author":"Sultana","year":"2020","journal-title":"Drug Saf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e017144","DOI":"10.1161\/JAHA.120.017144","article-title":"Experience With Hydroxychloroquine and Azithromycin in the Coronavirus Disease 2019 Pandemic: Implications for QT Interval Monitoring","volume":"9","author":"Ramireddy","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_22","unstructured":"University of Cambridge, MRC Cognition and Brain Sciences Unit (2022, May 19). Rules of Thumb on Magnitudes of Effect Sizes. Available online: https:\/\/imaging.mrc-cbu.cam.ac.uk\/statswiki\/FAQ\/effectSize."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/6\/764\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:23:48Z","timestamp":1760138628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/6\/764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,2]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["antibiotics11060764"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11060764","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,2]]}}}