Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission.
Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission.
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DOI：
10.1186/s12879-021-06219-z
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发表时间：
2021-06-02
影响因子：
3.7
通讯作者：
Pagkas-Bather J
中科院分区：
文献类型：
--
作者：
Pettit NN;Nguyen CT;Lew AK;Bhagat PH;Nelson A;Olson G;Ridgway JP;Pho MT;Pagkas-Bather J
尽管报告的合并感染发生率较低，但 COVID-19 患者通常会根据经验使用抗生素治疗社区获得性细菌性肺炎 (CABP)。需要采取管理干预措施，以促进在 COVID-19 患者中为 CABP 开出适当的抗生素处方。我们制定了 COVID-19 患者 CABP 抗生素开始和停用指南。本研究的目的是评估这种干预措施对 COVID-19 患者经验性 CABP 抗生素治疗持续时间的影响。这是一项单中心、回顾性、准实验研究，对象为 2020 年 3 月 1 日至 4 月 25 日期间入院的 COVID-19 肺炎成年患者，这些患者开始接受经验性 CABP 抗生素治疗。如果患者入院后 48 小时内开始使用抗生素或发现其他感染源，则患者被排除。主要结局是指南实施前（2020年3月1日至3月27日）和指南实施后（2020年3月28日至4月25日）的抗生素治疗持续时间（DOT）。我们还评估了开始使用经验性 CABP 抗生素的临床结果（死亡率、再入院、住院时间）。共有 506 名 COVID-19 患者接受了评估，其中 102 名干预前患者和 404 名干预后患者。在干预之前，74.5% (n = 76) 的 COVID-19 患者接受了经验性抗生素治疗，而干预后只有 42% 的患者 (n = 170) 接受了经验性抗生素治疗，p< 0.001。干预后组的中位 DOT 比干预前组短 1.3 天（p<0.001），针对非典型细菌的抗生素 DOT 减少了 2.8 天（p<0.001）。根据与我们指南一致的标准，干预后组中有更多患者开始使用抗生素（68% 对比 87%，p=0.001）。各组之间的临床结果没有差异。在实施概述了在 COVID-19 住院患者中开始和停用 CABP 抗生素的指南后，我们观察到抗生素处方和 DOT 有所减少。该指南还导致符合指南的经验性抗生素起始使用率显着增加。在线版本包含可在 10.1186/s12879-021-06219-z 获取的补充材料。
Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics > 48 h following admission or if another source of infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n = 76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n = 170), p < 0.001. The median DOT in the post-intervention group was 1.3 days shorter (p < 0.001) than the pre-intervention group, and antibiotics directed at atypical bacteria DOT was reduced by 2.8 days (p < 0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p = 0.001). There were no differences between groups in terms of clinical outcomes. Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation. The online version contains supplementary material available at 10.1186/s12879-021-06219-z.
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作者：
Marcos, Pedro J;Restrepo, Marcos I;Verea-Hernando, Hector
通讯作者：
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DOI：
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发表时间：
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影响因子：
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影响因子：
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