Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis.
Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis.
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DOI：
10.1016/j.cmi.2020.12.018
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
MacFadden DR
中科院分区：
文献类型：
--
作者：
Langford BJ;So M;Raybardhan S;Leung V;Soucy JR;Westwood D;Daneman N;MacFadden DR
感染SARS-CoV-2的患者使用抗生素的比例尚不确定，这可能导致患者伤害和全球抗生素耐药性。目的是估计COVID-19患者抗生素处方的患病率和相关因素。我们检索了MEDLINE、OVID Epub和EMBASE，检索了截至2020年6月9日的已发表的英语人类主题文献。我们纳入了随机对照试验；队列研究;≥10例病例；以及评估抗生素处方的实验或观察设计。研究参与者是实验室确诊的SARS-CoV-2感染患者，来自所有医疗机构（医院和社区）和年龄组（儿科和成人）。主要关注的结局是按地理区域、疾病严重程度和年龄分层的COVID-19患者使用抗生素的比例。我们使用随机效应荟萃分析合并比例数据。我们筛选了7469项研究，其中154项纳入最终分析。从30623例患者中获得抗生素数据。抗生素处方患病率为74.6% （95% CI 68.3-80.0%）。在单变量meta回归中，儿童的抗生素处方比成人低（处方患病率优势比（OR） 0.10, 95% CI 0.03-0.33）。抗生素处方随着患者年龄的增加而增加（OR为1.45 / 10年，95% CI为1.18-1.77），随着需要机械通气的患者比例的增加而增加（OR为1.33 / 10年，95% CI为1.15-1.54）。31项研究估计细菌合并感染为8.6% （95% CI 4.7-15.2%）。四分之三的COVID-19患者接受抗生素治疗，处方量明显高于细菌合并感染的估计流行率。在COVID-19患者中，不必要的抗生素使用可能很高。
The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
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