Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship.
Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship.
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DOI：
10.1007/s10096-020-04063-8
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Spinner CD
中科院分区：
文献类型：
--
作者：
Rothe K;Feihl S;Schneider J;Wallnöfer F;Wurst M;Lukas M;Treiber M;Lahmer T;Heim M;Dommasch M;Waschulzik B;Zink A;Querbach C;Busch DH;Schmid RM;Schneider G;Spinner CD
由严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）已在全球范围内蔓延。细菌合并感染与呼吸道病毒感染的不利结果相关;然而，与COVID-19相关的微生物和抗生素数据很少。在大流行期间，应根据抗生素管理（ABS）原则充分使用抗生素。我们对2020年2月至4月期间在德国大学医院住院的140名COVID-19患者的临床和微生物学特征进行了回顾性研究，重点关注细菌合并感染和抗菌治疗。最终随访日期为2020年5月6日。记录了140名COVID-19患者的临床数据：中位年龄为63.5岁（范围17-99岁）; 64%为男性。根据实施的当地ABS指南，最常用的抗生素方案为氨苄西林/舒巴坦（41.5%），中位持续时间为6天（范围1-13）。所有病例的嗜肺军团菌和肺炎链球菌尿抗原检测均为阴性。在入住重症监护室的重症患者（n = 50）中，检测到肠球菌（34.0%）和烟曲霉（18.0%）的合并感染。入院时收集的血培养显示诊断率为4.2%。细菌和真菌合并感染在COVID-19患者中很少见，主要在重症患者中流行。需要进一步的研究来评估抗生素治疗对COVID-19患者治疗结果的影响，以防止抗生素过度使用。ABS的指引可帮助优化COVID-19的管理。还需要调查重症COVID-19患者感染并发症的微生物模式。本文的在线版本（10.1007/s10096-020-04063-8）包含补充材料，可供授权用户使用。
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17–99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1–13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required. The online version of this article (10.1007/s10096-020-04063-8) contains supplementary material, which is available to authorized users.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
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作者：
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