Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2023 Jan 30;38(4):e37. doi: 10.3346/jkms.2023.38.e37.
The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality.
In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not.
Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching.
In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.
当对大多数患者进行微生物检测时，评估了 2019 年冠状病毒病（COVID-19）患者的细菌合并感染率和组成。我们还评估了经验性使用抗菌药物是否与死亡率相关。
在这项回顾性研究中，纳入了 2020 年 2 月至 2021 年 12 月期间在韩国一家三级医院住院的所有成年 COVID-19 患者。通过痰培养、血培养和包括聚合酶链反应痰检测和尿抗原检测在内的分子检测评估细菌合并感染。比较了接受经验性抗菌药物治疗和未接受抗菌药物治疗的患者的死亡率。
在研究期间，共有 367 名成年患者入院，其中 300 名（81.7%）有痰培养结果并纳入分析。在这 300 名患者中，127 名（42.3%）有抗生素暴露史。48 小时内合并感染率为 8.3%（25/300）：无抗生素暴露史的患者为 6.4%（11/173），有抗生素暴露史的患者为 11%（14/127）。合并感染的细菌根据入院前的抗菌暴露情况而不同，多药耐药病原体仅在抗菌暴露组中检出。在微生物检测结果为阴性的患者中，33.3%（100/300）使用了经验性抗菌药物。在倾向性评分匹配前后的研究队列中，经验性抗菌治疗与 30 天死亡率或住院死亡率均无显著相关性。
在本研究中，仅包括进行了微生物检测的患者，细菌合并感染并不常见，合并感染的病原体因先前的抗菌暴露而异。鉴于合并感染的罕见性和潜在益处的缺乏，COVID-19 中经验性使用抗菌药物应成为抗生素管理的一个重要目标。
