Antibiotic prescriptions in children with COVID-19 and Multisystem Inflammatory Syndrome: a multinational experience in 990 cases from Latin America

Background To date, there are no comprehensive data on antibiotic use in children with COVID 19 and Multisystem Inflammatory Syndrome (MIS C). Methods Multicenter cohort study from 5 Latin American countries. Children 17 years of age or younger with microbiologically confirmed SARSCoV2 infection or fulfilling MIS C definition were included. Antibiotic prescriptions were collected and factors associated with their use were calculated. Findings 990 children were included, with a median age of 3 years . Of these, 69 (7.0%) were diagnosed with MIS C. The prevalence of antibiotic use was 24.5% (n = 243). MIS-C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. On the contrary, lower respiratory tract infections without radiologic evidence of pneumonia/ARDS and not requiring respiratory support (OR = 0.34) were independently associated with decreased use of antibiotics. There was significant variation in antibiotic use across the hospitals. Conclusions Our study showed a relatively high rate of antibiotic prescriptions in children with COVID 19 and in particular in those with severe disease or MIS C. Importantly, we found a significant variation in reasons for prescriptions of antibiotics and type of chosen therapies, as well in hospital practices, highlighting current uncertainties and lack of guidelines for the recognition of bacterial infections in children with COVID-19. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID 19 children.