Van Laethem Johan, Wuyts Stephanie, Van Laere Sven, Dirkx Silke, Seyler Lucie, Mertens Rembert, Ilsen Bart, Lacor Patrick, Pierard Denis, Allard Sabine D
Department of Internal Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
Universitair Ziekenhuis Brussel (UZ Brussel), Hospital Pharmacy, Laarbeeklaan 101, 1090, Brussels, Belgium.
Infect Dis Ther. 2021 Dec;10(4):2575-2591. doi: 10.1007/s40121-021-00535-2. Epub 2021 Sep 16.
Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19.
In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis.
Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as 'appropriate'). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis.
In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19.
The study is registered at ClinicalTrials.gov (NCT04544072).
尽管新冠病毒疾病（COVID-19）患者很少出现细菌合并感染和重叠感染，但住院患者的抗生素总体处方率很高。为了应对抗生素过度处方的问题，抗生素管理团队需要有关COVID-19住院患者抗生素处方的可靠数据。
在这项前瞻性观察队列研究中，我们对2020年5月1日至11月2日期间入住比利时一家拥有721张床位的大学医院COVID-19病房的患者的抗生素处方进行了定量和定性评估。收集了人口统计学、临床和微生物学参数以及抗生素使用数据。计算了在（疑似）细菌性呼吸道感染情况下开具的抗生素的限定日剂量（DDD），并将其转换为两个指标：DDD/入院和DDD/100个住院床日。一组传染病专家对每张处方进行了合理性评估。进行了驱动因素分析，以确定确诊为COVID-19的患者中增加抗生素处方几率的因素。
在403名疑似COVID-19感染的合格参与者中，有281人被纳入研究。在203例确诊为COVID-19的入院患者中，13.8%的患者因（疑似）细菌性呼吸道合并/重叠感染而开始使用抗生素（0.86 DDD/入院；8.92 DDD/100个床日；39.4%被评为“合理”）。确定了抗生素处方的五个驱动因素：脑血管疾病史、男性患者中性粒细胞/淋巴细胞比例高、年龄、铁蛋白水平升高以及采集呼吸道样本进行细菌学分析。
在研究人群中，（疑似）细菌性呼吸道合并/重叠感染的抗生素使用量较低。特别是，确诊为COVID-19的患者的DDD总数较少，这表明抗生素使用是经过深思熟虑的。然而，抗生素管理计划对于应对COVID-19住院患者不必要和不适当的抗生素使用仍然至关重要。
该研究已在ClinicalTrials.gov（NCT04544072）注册。
