Chan Lynn, Gupta Simran, Sacco Alicia J, Kasule Sabirah N, Chaffin Hally, Feller Fionna F, Mi Lanyu, Lim Elisabeth S, Seville Maria Teresa
Department of Pharmacy, Ronald Reagan UCLA Medical Center, Los Angeles, California.
Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona.
Antimicrob Steward Healthc Epidemiol. 2023 Apr 17;3(1):e75. doi: 10.1017/ash.2023.135. eCollection 2023.
To evaluate the rate of coinfections and secondary infections seen in hospitalized patients with COVID-19 and antimicrobial prescribing patterns.
This single-center, retrospective study included all patients aged ≥18 years admitted with COVID-19 for at least 24 hours to a 280-bed, academic, tertiary-care hospital between March 1, 2020, and August 31, 2020. Coinfections, secondary infections, and antimicrobials prescribed for these patients were collected.
In total, 331 patients with a confirmed diagnosis of COVID-19 were evaluated. No additional cases were identified in 281 (84.9%) patients, whereas 50 (15.1%) had at least 1 infection. In total, of 50 patients (15.1%) who were diagnosed with coinfection or secondary infection had bacteremia, pneumonia, and/or urinary tract infections. Patients who had positive cultures, who were admitted to the ICU, who required supplemental oxygen, or who were transferred from another hospital for higher level of care were more likely to have infections. The most commonly used antimicrobials were azithromycin (75.2%) and ceftriaxone (64.9%). Antimicrobials were prescribed appropriately for 55% of patients.
Coinfection and secondary infections are common in patients who are critically ill with COVID-19 at hospital admission. Clinicians should consider starting antimicrobial therapy in critically ill patients while limiting antimicrobial use in patients who are not critically ill.
评估新型冠状病毒肺炎（COVID-19）住院患者的合并感染和继发感染率以及抗菌药物处方模式。
这项单中心回顾性研究纳入了2020年3月1日至2020年8月31日期间，因COVID-19入院至少24小时的所有年龄≥18岁的患者，该医院为一家拥有280张床位的学术性三级医疗机构。收集这些患者的合并感染、继发感染情况以及所开具的抗菌药物。
总共评估了331例确诊为COVID-19的患者。281例（84.9%）患者未发现其他感染病例，而50例（15.1%）患者至少有1次感染。在这50例（15.1%）被诊断为合并感染或继发感染的患者中，共有菌血症、肺炎和/或尿路感染。培养结果呈阳性、入住重症监护病房（ICU）、需要吸氧或从其他医院转来接受更高水平治疗的患者更易发生感染。最常用的抗菌药物是阿奇霉素（75.2%）和头孢曲松（64.9%）。55%的患者抗菌药物使用得当。
COVID-19重症住院患者中合并感染和继发感染很常见。临床医生应考虑对重症患者启动抗菌治疗，同时限制非重症患者的抗菌药物使用。
