Early Empiric Antibiotic Use in Patients Hospitalized With COVID-19: A Retrospective Cohort Study.

Autor:	Widere JC; Department of Medicine, University of Virginia, Charlottesville, VA., Davis CL; Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA., Loomba JJ; Integrated Translational Health Research Institute of Virginia, University of Virginia, Charlottesville, VA., Bell TD; Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA.; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA., Enfield KB; Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA., Barros AJ; Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2023 Sep 01; Vol. 51 (9), pp. 1168-1176. Date of Electronic Publication: 2023 May 01.
DOI:	10.1097/CCM.0000000000005901
Abstrakt:	Objective: To investigate temporal trends and outcomes associated with early antibiotic prescribing in patients hospitalized with COVID-19. Design: Retrospective propensity-matched cohort study using the National COVID Cohort Collaborative (N3C) database. Setting: Sixty-six health systems throughout the United States that were contributing to the N3C database. Centers that had fewer than 500 admissions in their dataset were excluded. Patients: Patients hospitalized with COVID-19 were included. Patients were defined to have early antibiotic use if they received at least 3 calendar days of intravenous antibiotics within the first 5 days of admission. Interventions: None. Measurements and Main Results: Of 322,867 qualifying first hospitalizations, 43,089 patients received early empiric antibiotics. Antibiotic use declined across all centers in the data collection period, from March 2020 (23%) to June 2022 (9.6%). Average rates of early empiric antibiotic use (EEAU) also varied significantly between centers (deviance explained 7.33% vs 20.0%, p < 0.001). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (odds ratio [OR] 3.57; 95% CI, 3.42-3.72), extracorporeal membrane oxygenation before day 2 (OR 2.14; 95% CI, 1.75-2.61), and early vasopressor use (OR 1.85; 95% CI, 1.78-1.93) but not region of residence was associated with EEAU. After propensity matching, EEAU was associated with an increased risk for in-hospital mortality (OR 1.27; 95% CI, 1.23-1.33), prolonged mechanical ventilation (OR 1.65; 95% CI, 1.50-1.82), late broad-spectrum antibiotic exposure (OR 3.24; 95% CI, 2.99-3.52), and late Clostridium difficile infection (OR 1.60; 95% CI, 1.37-1.87). Conclusions: Although treatment of COVID-19 patients with empiric antibiotics has declined during the pandemic, the frequency of use remains high. There is significant inter-center variation in antibiotic prescribing practices and evidence of potential harm. Our findings are hypothesis-generating and future work should prospectively compare outcomes and adverse events. Competing Interests: Dr. Loomba’s institution received funding from the National Center for Advancing Translational Sciences; she received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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