Public Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada.
Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Canada; University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
Clin Microbiol Infect. 2021 Apr;27(4):520-531. doi: 10.1016/j.cmi.2020.12.018. Epub 2021 Jan 5.
The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance.
The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19.
We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020.
We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing.
The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult).
The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis.
We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3-80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03-0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18-1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15-1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7-15.2%) from 31 studies.
Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
感染 SARS-CoV-2 的患者中有多少人被开具了抗生素尚不确定，而这可能会导致患者受到伤害并增加全球抗生素耐药性。
旨在评估 COVID-19 患者中抗生素使用的流行率及其相关因素。
我们检索了 MEDLINE、OVID Epub 和 EMBASE 上截至 2020 年 6 月 9 日发表的人类主题的文献。
纳入了随机对照试验；队列研究；纳入了≥10 例患者的病例系列研究；以及评估抗生素使用的实验或观察性设计的研究。
研究对象为实验室确诊的 SARS-CoV-2 感染患者，来自所有医疗保健环境（医院和社区）和年龄组（儿科和成人）。
主要结局指标是按地理位置、疾病严重程度和年龄分层的 COVID-19 患者使用抗生素的比例。我们使用随机效应荟萃分析汇总了比例数据。
我们共筛选了 7469 篇研究，其中 154 篇最终纳入分析。30623 例患者提供了抗生素使用数据。抗生素使用的流行率为 74.6%（95%CI 68.3-80.0%）。单变量荟萃回归显示，与成年人相比，儿童使用抗生素的比例较低（用药比数比 0.10，95%CI 0.03-0.33）。随着患者年龄的增加，抗生素使用比例也会增加（每增加 10 岁，OR 1.45，95%CI 1.18-1.77），随着需要机械通气的患者比例增加，抗生素使用比例也会增加（每增加 10%，OR 1.33，95%CI 1.15-1.54）。31 项研究估计合并细菌感染率为 8.6%（95%CI 4.7-15.2%）。
四分之三的 COVID-19 患者使用了抗生素，这一比例明显高于合并细菌感染的估计流行率。COVID-19 患者的抗生素使用很可能是不必要的。
