Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?

Autor:	Ng TM; Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore., Ong SWX; Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore.; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore., Loo AYX; Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore., Tan SH; Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore., Tay HL; Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore., Yap MY; Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore., Lye DC; Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore.; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore., Lee TH; Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore.; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore., Young BE; Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore.; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
Jazyk:	angličtina
Zdroj:	Antibiotics (Basel, Switzerland) [Antibiotics (Basel)] 2022 Jan 31; Vol. 11 (2). Date of Electronic Publication: 2022 Jan 31.
DOI:	10.3390/antibiotics11020184
Abstrakt:	Background: COVID-19 imposes challenges in antibiotic decision-making due to similarities between bacterial pneumonia and moderate to severe COVID-19. We evaluated the effects of antibiotic therapy on the clinical outcomes of COVID-19 pneumonia patients and diagnostic accuracy of key inflammatory markers to inform antibiotic decision-making. Methods: An observational cohort study was conducted in patients hospitalised with COVID-19 at the National Centre for Infectious Diseases and Tan Tock Seng Hospital, Singapore, from January to April 2020. Patients were defined as receiving empiric antibiotic treatment for COVID-19 if started within 3 days of diagnosis. Results: Of 717 patients included, 86 (12.0%) were treated with antibiotics and 26 (3.6%) had documented bacterial infections. Among 278 patients with COVID-19 pneumonia, those treated with antibiotics had more diarrhoea (26, 34.7% vs. 24, 11.8%, p < 0.01), while subsequent admissions to the intensive care unit were not lower (6, 8.0% vs. 10, 4.9% p = 0.384). Antibiotic treatment was not independently associated with lower 30-day (adjusted odds ratio, aOR 19.528, 95% confidence interval, CI 1.039-367.021) or in-hospital mortality (aOR 3.870, 95% CI 0.433-34.625) rates after adjusting for age, co-morbidities and severity of COVID-19 illness. Compared to white cell count and procalcitonin level, the C-reactive protein level had the best diagnostic accuracy for documented bacterial infections (area under the curve, AUC of 0.822). However, the sensitivity and specificity were less than 90%. Conclusion: Empiric antibiotic use in those presenting with COVID-19 pneumonia did not prevent deterioration or mortality. More studies are needed to evaluate strategies to diagnose bacterial co-infections in these patients.
Databáze:	MEDLINE
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