Taha Inass, Abdou Yasser, Hammad Ikhlas, Nady Omnia, Hassan Gamal, Farid Magdy F, Alofi Fadwa S, Alharbi Najla, Salamah Emad, Aldeeb Nawaf, Elmehallawy Ghaidaa, Alruwathi Rehab, Sarah Elmaghraby, Rashad Alhusainin, Rammah Ola, Shoaib Hassan, Omar Mohammed ElSagheer, Elmehallawy Yara, Kassim Saba
Department of Medicine, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia.
Department of Medicine, Ohud Hospital, Al-Madinah Al-Munawara, Saudi Arabia.
Infect Drug Resist. 2022 Dec 14;15:7401-7411. doi: 10.2147/IDR.S386162. eCollection 2022.
Most patients admitted to intensive care units (ICUs) with severe Corona Virus Disease 2019 (COVID-19) pneumonia receive antibacterial antibiotics with little evidence of bacterial infections.
This study was designed to review the profiles of patients with severe COVID-19 pneumonia requiring intensive care, the rate of bacterial coinfection, the antibiotics used, and their relation to patient outcomes (death or recovery).
This was a retrospective study that reviewed the medical records of all patients with confirmed COVID-19 (n = 120) severe pneumonia admitted directly from the emergency room to the intensive care unit, at a public hospital during the period from May 2020 to April 2021. The data collected included patients' demographic and laboratory data, comorbidities, antibiotic treatment, and their outcome. Descriptive statistics, bivariate inferential analysis tests (chi-square and unpaired T-Tests) and multivariable binary logistic regression were performed.
The mean age of the patients was 56.8 ± 16.5 years old, and among them, 74 (62.7%) were males. Of the included patients, 92 (77.0%) had comorbidities, 76 (63.3%) required mechanical ventilation and 30 (25%) died. All patients received empirical antibiotics for suspected bacterial coinfection. The most common antibiotics used were azithromycin (n = 97, 8%) and imipenem (n = 83, 9%). Ninety patients (75%) were on two empirical antibiotics. Early positive cultures for pathogens were found only in four patients (3.3%), whereas 36 (30%) patients had positive cultures 5-10 days after admission. The most frequently isolated pathogens were (n = 16) and coagulase-negative Staphylococci (n = 14). In bivariate analysis empirical treatment with azithromycin resulted in a significantly lower mortality rate (p = 0.023), meanwhile mechanical ventilation, days of stay in intensive care unit, morbidities (e.g., lung disease), linezolid and, vancomycin use associated with mortality (p< 0.05). The adjusted logistic regression, controlling for age and gender, revealed that azithromycin antibiotic was more likely protective from mortality (OR= 0.22, 95%CI 0.06-0.85, p=0.028. However, patients with lung diseases and under mechanical ventilation were 35.21 and 19.57 more likely to die (95%CI =2.84-436.70, p=0.006; 95%CI=2.66-143.85, p=0.003, respectively).
Bacterial coinfection with severe COVID-19 pneumonia requiring intensive care was unlikely. The benefit of Azithromycin over other antibiotics could be attributed to its anti-inflammatory properties rather than its antibacterial effect.
大多数因2019年冠状病毒病（COVID-19）重症肺炎入住重症监护病房（ICU）的患者在几乎没有细菌感染证据的情况下接受了抗菌抗生素治疗。
本研究旨在回顾需要重症监护的COVID-19重症肺炎患者的概况、细菌合并感染率、使用的抗生素及其与患者结局（死亡或康复）的关系。
这是一项回顾性研究，回顾了2020年5月至2021年4月期间在一家公立医院从急诊室直接入住重症监护病房的所有确诊COVID-19（n = 120）重症肺炎患者的病历。收集的数据包括患者的人口统计学和实验室数据、合并症、抗生素治疗及其结局。进行了描述性统计、双变量推断分析测试（卡方检验和非配对T检验）以及多变量二元逻辑回归分析。
患者的平均年龄为56.8±16.5岁，其中74名（62.7%）为男性。纳入的患者中，92名（77.0%）有合并症，76名（63.3%）需要机械通气，30名（25%）死亡。所有患者均因怀疑合并细菌感染而接受经验性抗生素治疗。最常用的抗生素是阿奇霉素（n = 97，8%）和亚胺培南（n = 83，9%）。90名患者（75%）接受了两种经验性抗生素治疗。仅在4名患者（3.3%）中发现早期病原体培养阳性，而36名（30%）患者在入院后5 - 10天培养阳性。最常分离出的病原体是[此处原文缺失具体病原体名称]（n = 16）和凝固酶阴性葡萄球菌（n = 14）。在双变量分析中，阿奇霉素经验性治疗导致死亡率显著降低（p = 0.023），同时机械通气、在重症监护病房的住院天数、合并症（如肺部疾病）、利奈唑胺和万古霉素的使用与死亡率相关（p<0.05）。调整后的逻辑回归分析，控制年龄和性别后，显示阿奇霉素抗生素更有可能降低死亡率（OR = 0.22，95%CI 0.06 - 0.85，p = 0.028）。然而，患有肺部疾病和接受机械通气的患者死亡可能性分别高35.21倍和19.57倍（95%CI = 2.84 - 436.70，p = 0.006；95%CI = 2.66 - 143.85，p = 0.003）。
需要重症监护的COVID-19重症肺炎合并细菌感染的可能性不大。阿奇霉素相对于其他抗生素的益处可能归因于其抗炎特性而非抗菌作用。
