Early viral versus late antibiotic-associated diarrhea in novel coronavirus infection.

Autor:	Maslennikov R; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation.; The Interregional Public Organization 'Scientific Community for the Promotion of the Clinical Study of the Human Microbiome,' Moscow, Russian Federation.; Consultative and Diagnostic Center 2 of the Moscow City Health Department, Moscow, Russian Federation., Svistunov A; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Ivashkin V; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Ufimtseva A; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Poluektova E; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation.; The Interregional Public Organization 'Scientific Community for the Promotion of the Clinical Study of the Human Microbiome,' Moscow, Russian Federation., Efremova I; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Ulyanin A; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Okhlobystin A; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Kardasheva S; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Kurbatova A; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Levshina A; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Grigoriadis D; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Magomedov S; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Dzhakhaya N; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Shifrin O; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Zharkova M; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Yuryeva E; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Kokina N; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Shirtladze M; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation., Kiseleva O; Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2021 Oct 15; Vol. 100 (41), pp. e27528.
DOI:	10.1097/MD.0000000000027528
Abstrakt:	Abstract: Diarrhea is one of the manifestations of the novel coronavirus disease (COVID-19), but it also develops as a complication of massive antibiotic therapy in this disease. This study aimed to compare these types of diarrhea.We included patients with COVID-19 in a cohort study and excluded patients with chronic diarrhea, laxative use, and those who died during the first day of hospitalization.There were 89 (9.3%), 161 (16.7%), and 731 (75.7%) patients with early viral, late antibiotic-associated, and without diarrhea, respectively. Late diarrhea lasted longer (6 [4-10] vs 5 [3-7] days, P < .001) and was more severe. Clostridioides difficile was found in 70.5% of tested patients with late diarrhea and in none with early diarrhea. Presence of late diarrhea was associated with an increased risk of death after 20 days of disease (P = .009; hazard ratio = 4.7). Patients with late diarrhea had a longer hospital stay and total disease duration, and a higher proportion of these patients required intensive care unit admission. Oral amoxicillin/clavulanate (odds ratio [OR] = 2.23), oral clarithromycin (OR = 3.79), and glucocorticoids (OR = 4.41) use was a risk factor for the development of late diarrhea, while ceftriaxone use (OR = 0.35) had a protective effect. Before the development of late diarrhea, decrease in C-reactive protein levels and increase in lymphocyte count stopped but the white blood cell and neutrophil count increased. An increase in neutrophils by >0.6 × 109 cells/L predicted the development of late diarrhea in the coming days (sensitivity 82.0%, specificity 70.8%, area under the curve = 0.791 [0.710-0.872]).Diarrhea in COVID-19 is heterogeneous, and different types of diarrhea require different management. Competing Interests: The authors reprot no conflicts of interest. (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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