Department of Medical Microbiology and Infection Control, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.
Clin Microbiol Infect. 2021 Jan;27(1):61-66. doi: 10.1016/j.cmi.2020.09.041. Epub 2020 Oct 1.
The Dutch Working Party on Antibiotic Policy constituted a multidisciplinary expert committee to provide evidence-based recommendation for the use of antibacterial therapy in hospitalized adults with a respiratory infection and suspected or proven 2019 Coronavirus disease (COVID-19).
We performed a literature search to answer four key questions. The committee graded the evidence and developed recommendations by using Grading of Recommendations Assessment, Development, and Evaluation methodology.
We assessed evidence on the risk of bacterial infections in hospitalized COVID-19 patients, the associated bacterial pathogens, how to diagnose bacterial infections and how to treat bacterial infections. Bacterial co-infection upon admission was reported in 3.5% of COVID-19 patients, while bacterial secondary infections during hospitalization occurred up to 15%. No or very low quality evidence was found to answer the other key clinical questions. Although the evidence base on bacterial infections in COVID-19 is currently limited, available evidence supports restrictive antibiotic use from an antibiotic stewardship perspective, especially upon admission. To support restrictive antibiotic use, maximum efforts should be undertaken to obtain sputum and blood culture samples as well as pneumococcal urinary antigen testing. We suggest to stop antibiotics in patients who started antibiotic treatment upon admission when representative cultures as well as urinary antigen tests show no signs of involvement of bacterial pathogens after 48 hours. For patients with secondary bacterial respiratory infection we recommend to follow other guideline recommendations on antibacterial treatment for patients with hospital-acquired and ventilator-associated pneumonia. An antibiotic treatment duration of five days in patients with COVID-19 and suspected bacterial respiratory infection is recommended upon improvement of signs, symptoms and inflammatory markers. Larger, prospective studies about the epidemiology of bacterial infections in COVID-19 are urgently needed to confirm our conclusions and ultimately prevent unnecessary antibiotic use during the COVID-19 pandemic.
荷兰抗生素政策工作组组建了一个多学科专家委员会，为住院的呼吸道感染成人患者提供使用抗菌治疗的循证建议，这些患者疑似或确诊患有 2019 冠状病毒病（COVID-19）。
我们进行了文献检索，以回答四个关键问题。委员会使用 Grading of Recommendations Assessment, Development, and Evaluation 方法对证据进行分级，并制定推荐意见。
我们评估了住院 COVID-19 患者发生细菌感染的风险、相关的细菌病原体、如何诊断细菌感染以及如何治疗细菌感染的证据。COVID-19 患者入院时报告有 3.5%合并细菌感染，而住院期间发生继发性细菌感染的比例高达 15%。对于其他关键临床问题，没有或仅有非常低质量的证据。尽管 COVID-19 中细菌感染的证据基础目前有限，但现有证据支持从抗生素管理的角度限制抗生素的使用，特别是在入院时。为了支持限制抗生素的使用，应尽最大努力获取痰和血培养样本以及肺炎球菌尿抗原检测。我们建议在入院时开始接受抗生素治疗的患者中，如果代表性培养物以及尿抗原检测在 48 小时后没有显示细菌病原体参与的迹象，应停止抗生素治疗。对于继发细菌性呼吸道感染的患者，我们建议遵循其他指南推荐的抗菌治疗方案，用于治疗医院获得性和呼吸机相关性肺炎的患者。对于 COVID-19 患者和疑似细菌性呼吸道感染的患者，建议在体征、症状和炎症标志物改善后，使用抗生素治疗 5 天。迫切需要更大规模的前瞻性研究来确定 COVID-19 中细菌感染的流行病学，以确认我们的结论并最终防止在 COVID-19 大流行期间不必要地使用抗生素。
