Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Int J Antimicrob Agents. 2022 Jan;59(1):106462. doi: 10.1016/j.ijantimicag.2021.106462. Epub 2021 Oct 23.
The use of antibiotics was common in some countries during the early phase of the coronavirus disease 2019 (COVID-19) pandemic, but adequate evaluation remains lacking. This study aimed to evaluate the effect of early antibiotic use in patients with non-severe COVID-19 admitted without bacterial infection.
This multi-centre retrospective cohort study included 1,373 inpatients with non-severe COVID-19 admitted without bacterial infection. Patients were divided into two groups according to their exposure to antibiotics within 48 h of admission. The outcomes were progression to severe COVID-19, length of stay >15 days and mortality rate. A mixed-effect Cox model and random effect logistic regression were used to explore the association between early antibiotic use and outcomes.
During the 30-day follow-up period, the proportion of patients who progressed to severe COVID-19 in the early antibiotic use group was almost 1.4 times that of the comparison group. In the mixed-effect model, the early use of antibiotics was associated with higher probability of developing severe COVID-19 and staying in hospital for >15 days. However, there was no significant association between early use of antibiotics and mortality. Analysis with propensity-score-matched cohorts displayed similar results. In subgroup analysis, patients receiving any class of antibiotic were at increased risk of adverse health outcomes. Azithromycin did not improve disease progression and length of stay in patients with COVID-19.
It is suggested that antibiotic use should be avoided unless absolutely necessary in patients with non-severe COVID-19, particularly in the early stages.
在新冠病毒病 2019（COVID-19）大流行早期，一些国家普遍使用抗生素，但仍缺乏充分的评估。本研究旨在评估无细菌感染的非重症 COVID-19 住院患者早期使用抗生素的效果。
本多中心回顾性队列研究纳入了 1373 名无细菌感染的非重症 COVID-19 住院患者。根据入院 48 小时内是否使用抗生素，将患者分为两组。结局指标为进展为重症 COVID-19、住院时间>15 天和死亡率。采用混合效应 Cox 模型和随机效应逻辑回归探讨早期使用抗生素与结局之间的关联。
在 30 天的随访期间，早期使用抗生素组进展为重症 COVID-19 的患者比例几乎是对照组的 1.4 倍。在混合效应模型中，早期使用抗生素与发生重症 COVID-19 和住院时间>15 天的概率增加相关。然而，早期使用抗生素与死亡率之间无显著关联。倾向评分匹配队列分析显示出相似的结果。亚组分析显示，使用任何类别的抗生素的患者发生不良健康结局的风险增加。阿奇霉素并未改善 COVID-19 患者的疾病进展和住院时间。
建议除非绝对必要，否则非重症 COVID-19 患者应避免使用抗生素，尤其是在早期阶段。
