Chan X H S, O'Connor C J, Martyn E, Clegg A J, Choy B J K, Soares A L, Shulman R, Stone N R H, De S, Bitmead J, Hail L, Brealey D, Arulkumaran N, Singer M, Wilson A P R
Department of Clinical Microbiology, University College London NHS Foundation Trust, London, UK; Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Department of Clinical Microbiology, University College London NHS Foundation Trust, London, UK.
J Hosp Infect. 2022 Jun;124:37-46. doi: 10.1016/j.jhin.2022.03.007. Epub 2022 Mar 23.
The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multi-professional communication became more difficult, weakening stewardship activities.
To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves.
Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single-centre teaching hospital intensive care unit. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months.
From March 9, 2020 to September 2, 2020 (Wave 1), there were 156 patients and between September 3, 2020 and February 1, 2021 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%; P < 0.01) and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days; P = 0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235; P < 0.01) and bacteraemia from a respiratory source (3/156 vs 20/235; P < 0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens.
Reduced broad-spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.
由于诊断不确定性，尤其是在重症监护中，新冠疫情增加了广谱抗生素的使用。多专业沟通变得更加困难，削弱了管理活动。
确定在重症监护中，新冠患者在第一波和第二波疫情期间细菌合并/继发感染、使用的抗生素以及死亡率的变化。
在一家单中心教学医院重症监护病房进行前瞻性审计，比较疫情前两波期间细菌合并/继发感染及其治疗情况。在11个月内收集了确诊为新冠感染患者的人口统计学数据、每日抗生素使用情况、临床结局和培养结果。
从2020年3月9日至2020年9月2日（第一波），有156例患者；从2020年9月3日至2021年2月1日（第二波），有235例新冠感染患者入住重症监护病房。两波疫情期间的死亡率或血培养阳性率无显著差异。第二波中接受抗菌治疗的患者比例（93.0%对81.7%；P<0.01）和美罗培南使用时长（中位数（四分位间距）：5（2 - 7）天对3（2 - 5）天；P = 0.01）较低。然而，第二波中铜绿假单胞菌呼吸道分离株患者数量（4/156对21/235；P<0.01）和呼吸道来源的菌血症患者数量（3/156对20/235；P<0.01）增加，与感染暴发有关。在分离其他病原体方面，两波之间无显著差异。
与第一波相比，第二波新冠疫情期间广谱抗菌药物使用的减少与死亡率的显著变化无关。
