Moffitt Kristin L, Nakamura Mari M, Young Cameron C, Newhams Margaret M, Halasa Natasha B, Reed J Nelson, Fitzgerald Julie C, Spinella Philip C, Soma Vijaya L, Walker Tracie C, Loftis Laura L, Maddux Aline B, Kong Michele, Rowan Courtney M, Hobbs Charlotte V, Schuster Jennifer E, Riggs Becky J, McLaughlin Gwenn E, Michelson Kelly N, Hall Mark W, Babbitt Christopher J, Cvijanovich Natalie Z, Zinter Matt S, Maamari Mia, Schwarz Adam J, Singh Aalok R, Flori Heidi R, Gertz Shira J, Staat Mary A, Giuliano John S, Hymes Saul R, Clouser Katharine N, McGuire John, Carroll Christopher L, Thomas Neal J, Levy Emily R, Randolph Adrienne G
Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2023 Mar 6;10(3):ofad122. doi: 10.1093/ofid/ofad122. eCollection 2023 Mar.
Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.
We evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.
Of the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01-1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05-1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36-2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15-4.62]) was associated with bacterial coinfection.
Community-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely.
据报道，2019冠状病毒病（COVID-19）住院成人患者中社区获得性细菌合并感染并不常见，尽管经验性使用抗生素的情况很普遍。然而，关于COVID-19重症儿童经验性使用抗生素和细菌合并感染的数据却很少。
我们评估了2020年3月至12月期间因COVID-19入住儿科重症监护病房或高 acuity 病房的19岁以下儿童和青少年。根据入院前3天符合条件的微生物学结果，我们判定患者是否患有社区获得性细菌合并感染。我们比较了入院早期（1）接受抗生素治疗和（2）发生细菌合并感染的患者与未发生上述情况患者的人口统计学和临床特征。使用泊松回归模型，我们评估了与这些结果相关的因素。
在532例患者中，63.3%接受了经验性抗生素治疗，但只有7.1%发生细菌合并感染，只有3.0%发生呼吸道细菌合并感染。在多变量分析中，免疫功能低下患者（调整后相对风险[aRR]，1.34[95%置信区间{CI}，1.01-1.79]）、需要除机械通气以外的任何呼吸支持的患者（aRR，1.41[95%CI，1.05-1.90]）或需要有创机械通气的患者（aRR，1.83[95%CI，1.36-2.47]）（与无呼吸支持相比）更有可能接受经验性抗生素治疗。除哮喘外存在肺部合并症（aRR，2.31[95%CI，1.15-4.62]）与细菌合并感染相关。
COVID-19重症儿童社区获得性细菌合并感染并不常见，但经验性使用抗生素很普遍。这些发现为抗菌药物的使用提供了依据，并支持在评估显示不太可能发生合并感染时迅速降级治疗。
