Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study
Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study
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DOI：
10.1093/cid/ciaa1239
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发表时间：
2021-01-04
影响因子：
11.8
通讯作者：
Flanders, Scott A.
中科院分区：
文献类型：
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作者：
Vaughn, Valerie M.;Gandhi, Tejal N.;Flanders, Scott A.
背景出于对2019冠状病毒病（COVID-19）中细菌合并感染的担忧，可能会启动抗菌药物。我们确定了COVID-19住院患者经验性抗菌治疗和社区发病细菌合并感染的患病率和预测因素。2020年3月13日至2020年6月18日期间，密歇根州38家医院的1705名COVID-19住院患者的随机抽样队列。收集早期（住院2天内）经验性抗菌治疗和社区发病的细菌合并感染（微生物检测阳性天数）的数据。采用Poisson广义估计方程模型对预测因子进行评价。在1705名COVID-19患者中，56.6%的患者接受了早期经验性抗菌治疗; 3.5%（59/1705）的患者确诊为社区发病的细菌感染。在各医院中，早期经验性抗菌药物使用率从27%到84%不等。如果患者年龄较大，则更有可能接受早期经验性抗菌治疗（校正率比[ARR]：1.04 [1.00-1.08]/10年）;体重指数较低（ARR：0.99 [0.99-1.00]每公斤/米（2）），病情更严重（例如，严重脓毒症; ARR：1.16 [1.07-1.27]）、肺叶浸润（ARR：1.21 [1.04-1.42]）;或入住营利性医院（ARR：1.30 [1.15-1.47]）。随着时间的推移，COVID-19测试周转时间（已返回
Background. Antibacterials may be initiated out of concern for bacterial coinfection in coronavirus disease 2019 (COVID-19). We determined prevalence and predictors of empiric antibacterial therapy and community-onset bacterial coinfections in hospitalized patients with COVID-19.Methods. A randomly sampled cohort of 1705 patients hospitalized with COVID-19 in 38 Michigan hospitals between 3/13/2020 and 6/18/2020. Data were collected on early (within 2 days of hospitalization) empiric antibacterial therapy and community-onset bacterial coinfections (positive microbiologic test days). Poisson generalized estimating equation models were used to assess predictors.Results. Of 1705 patients with COVID-19, 56.6% were prescribed early empiric antibacterial therapy; 3.5% (59/1705) had a confirmed community-onset bacterial infection. Across hospitals, early empiric antibacterial use varied from 27% to 84%. Patients were more likely to receive early empiric antibacterial therapy if they were older (adjusted rate ratio [ARR]: 1.04 [1.00-1.08] per 10 years); had a lower body mass index (ARR: 0.99 [0.99-1.00] per kg/m(2)), more severe illness (eg, severe sepsis; ARR: 1.16 [1.07-1.27]), a lobar infiltrate (ARR: 1.21 [1.04-1.42]); or were admitted to a for-profit hospital (ARR: 1.30 [1.15-1.47]). Over time, COVID-19 test turnaround time (returned