Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Av. Javier Mina 301, Col. Centro, C.P. 28000, Colima, Colima, Mexico.
Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las Víboras, C.P. 28040, Colima, Colima, Mexico.
BMC Infect Dis. 2022 Jun 10;22(1):532. doi: 10.1186/s12879-022-07516-x.
The empirical prescription of antibiotics to inpatients with Coronavirus Disease 2019 (COVID-19) is frequent despite uncommon bacterial coinfections. Current knowledge of the effect of antibiotics on the survival of hospitalized children with COVID-19 is limited.
To characterize the survival experience of children with laboratory-positive COVID-19 in whom antibiotics were prescribed at hospital admission.
A retrospective cohort study was conducted in Mexico, with children hospitalized due to COVID-19 from March 2020 to December 2021. Data from 1601 patients were analyzed using the Kaplan-Meier method and the log-rank test. We computed hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the effect of the analyzed exposures on disease outcomes.
Antibiotics were prescribed to 13.2% ([Formula: see text] = 211) of enrolled children and a higher mortality rate [14.9 (95% CI 10.1-19.8) vs. 8.3 (95% CI 6.8-9.8)] per 1000 person-days, [Formula: see text] < 0.001) was found among them. At any given cut-off, survival functions were lower in antibiotic-positive inpatients ([Formula: see text] < 0.001). In the multiple model, antibiotic prescription was associated with a 50% increase in the risk of fatal outcome (HR = 1.50, 95% CI 1.01-2.22). A longer interval between illness onset and healthcare-seeking and pneumonia at hospital admission was associated with a poorer prognosis.
Our results suggest that antibiotic prescription in children hospitalized due to COVID-19 is associated with decreased survival. If later replicated, these findings highlight the need for rational antibiotics in these patients.
尽管 COVID-19 （新冠肺炎）少见合并细菌感染，经验性给住院患者开抗生素的情况仍很常见。目前，有关抗生素对住院 COVID-19 患儿生存影响的知识有限。
描述住院 COVID-19 患儿的生存情况，这些患儿在入院时被开具了抗生素。
在墨西哥进行了一项回顾性队列研究，纳入了 2020 年 3 月至 2021 年 12 月因 COVID-19 住院的儿童。采用 Kaplan-Meier 方法和对数秩检验对 1601 例患者的数据进行分析。我们计算了危害比（HR）和 95%置信区间（CI），以评估分析暴露因素对疾病结局的影响。
13.2%（[Formula: see text] = 211）的入组患儿被开具了抗生素，每 1000 人天的死亡率更高[14.9（95%CI 10.1-19.8）比 8.3（95%CI 6.8-9.8）]，[Formula: see text] < 0.001）。在任何给定的截止值下，抗生素阳性的住院患儿的生存函数较低（[Formula: see text] < 0.001）。在多模型中，抗生素处方与致命结局风险增加 50%相关（HR = 1.50，95%CI 1.01-2.22）。发病与寻求医疗保健之间的时间间隔较长以及入院时的肺炎与预后较差相关。
我们的结果表明，COVID-19 住院患儿开具抗生素与生存率降低有关。如果后续得到证实，这些发现强调了这些患者中抗生素使用需要合理。
