Cheng Lily Shui-Kuen, Chau Sandy Ka-Yee, Tso Eugene Yuk-Keung, Tsang Steven Woon-Choy, Li Issac Yuk-Fai, Wong Barry Kin-Chung, Fung Kitty Sau-Chun
Department of Pathology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong Special Administrative Region, China.
Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region, China.
Ther Adv Infect Dis. 2020 Dec 7;7:2049936120978095. doi: 10.1177/2049936120978095. eCollection 2020 Jan-Dec.
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected millions of individuals since December 2019, resulting in significant morbidity and mortality globally. During the 1918 Influenza Pandemic, it was observed that influenza was associated with bacterial co-infections. However, empirical or prophylactic antibiotic use during viral pandemics should be balanced against the associated adverse drug events.
In this retrospective cohort study, we investigated bacterial co-infections in adults with COVID-19 in Hong Kong. Notably, at the time of writing this report, patients with varying disease severities were isolated in hospitals until confirmatory evidence of virological clearance or immunity was available. The study included adults with laboratory-confirmed COVID-19 admitted to a single hospital cluster between 8 January 2020 and 1 May 2020. We obtained data regarding patient demographics, clinical presentations, blood test results, treatment, and outcomes. Bacteriological profiles and risk factors for co-infections were investigated. Antibiotic prescription practices were also reviewed.
Of the 147 patients recruited, clinical disease was suspected in 42% ( = 62) of patients who underwent testing for other respiratory infections. Notably, 35% ( = 52) of the patients were prescribed empirical antibiotics, predominantly penicillins or cephalosporins. Of these, 35% ( = 18) received more than one class of antibiotics and 37% ( = 19) received empirical antibiotics for over 1 week. Overall, 8.2% ( = 12) of patients developed bacterial co-infections since the detection of COVID-19 until discharge. Methicillin-susceptible was the most common causative pathogen identified. Although 8.2% ( = 12) of patients developed hypoxia and required oxygen therapy, no mortality was observed. Multivariate analysis showed that pneumonic changes on chest radiography at the time of admission predicted bacterial co-infections.
These findings emphasise the importance of judicious administration of antibiotics throughout the disease course of COVID-19 and highlight the role of antimicrobial stewardship during a pandemic.
2019年冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，自2019年12月以来已感染数百万人，在全球范围内导致了显著的发病率和死亡率。在1918年流感大流行期间，人们观察到流感与细菌合并感染有关。然而，在病毒大流行期间经验性或预防性使用抗生素应与相关的药物不良事件相权衡。
在这项回顾性队列研究中，我们调查了香港成年COVID-19患者的细菌合并感染情况。值得注意的是，在撰写本报告时，不同疾病严重程度的患者在医院进行隔离，直至获得病毒学清除或免疫的确切证据。该研究纳入了2020年1月8日至2020年5月1日期间入住单个医院集群的实验室确诊COVID-19成年患者。我们获取了有关患者人口统计学、临床表现、血液检查结果、治疗和结局的数据。调查了合并感染的细菌学特征和危险因素。还审查了抗生素处方做法。
在招募的147例患者中，42%（n = 62）接受其他呼吸道感染检测的患者被怀疑患有临床疾病。值得注意的是，35%（n = 52）的患者接受了经验性抗生素治疗，主要是青霉素或头孢菌素。其中，35%（n = 18）接受了不止一类抗生素治疗，37%（n = 19）接受经验性抗生素治疗超过1周。总体而言，自检测出COVID-19至出院，8.2%（n = 12）的患者发生了细菌合并感染。甲氧西林敏感金黄色葡萄球菌是最常见的致病菌。虽然8.2%（n = 12）的患者出现缺氧并需要吸氧治疗，但未观察到死亡病例。多因素分析显示，入院时胸部X线片上的肺部改变可预测细菌合并感染。
这些发现强调了在COVID-19疾病全过程中明智使用抗生素的重要性，并突出了大流行期间抗菌药物管理的作用。
