Merck & Co., Inc, Kenilworth, NJ, USA.
Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ, USA.
BMC Infect Dis. 2023 Jul 24;23(1):490. doi: 10.1186/s12879-023-08453-z.
Antibiotic usage and antibiotic resistance (ABR) patterns changed during the COVID-19 pandemic. Inadequate empiric antibiotic therapy (IET) is a significant public health problem and contributes to ABR. We evaluated factors associated with IET before and during the COVID-19 pandemic to determine the impact of the pandemic on antibiotic management.
This multicenter, retrospective cohort analysis included hospitalized US adults who had a positive bacterial culture (specified gram-positive or gram-negative bacteria) from July 2019 to October 2021 in the BD Insights Research Database. IET was defined as antibacterial therapy within 48 h that was not active against the bacteria. ABR results were based on susceptibility testing and reports from local facilities. Multivariate analysis was used to identify risk factors associated with IET in patients with any positive bacterial culture and ABR-positive cultures, including multidrug-resistant (MDR) bacteria.
Of 278,344 eligible patients in 269 hospitals, 56,733 (20.4%) received IET; rates were higher in patients with ABR-positive (n = 93,252) or MDR-positive (n = 39,000) cultures (34.9% and 45.0%, respectively). Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-positive patients had significantly higher rates of IET (25.9%) compared with SARS-CoV-2-negative (20.3%) or not tested (19.7%) patients overall and in the ABR and MDR subgroups. Patients with ABR- or MDR-positive cultures had more days of therapy and longer lengths of stay. In multivariate analyses, ABR, MDR, SARS-CoV-2-positive status, respiratory source, and prior admissions were identified as key IET risk factors.
IET remained a persistent problem during the COVID-19 pandemic and occurred at higher rates in patients with ABR/MDR bacteria or a co-SARS-CoV-2 infection.
在 COVID-19 大流行期间，抗生素的使用和抗生素耐药性（ABR）模式发生了变化。经验性抗生素治疗不足（IET）是一个重大的公共卫生问题，也是导致 ABR 的原因之一。我们评估了大流行前后与 IET 相关的因素，以确定大流行对抗生素管理的影响。
这项多中心、回顾性队列分析纳入了 2019 年 7 月至 2021 年 10 月期间在 BD Insights Research Database 中接受过阳性细菌培养（指定革兰阳性或革兰阴性细菌）的美国住院成年患者。IET 的定义为在 48 小时内使用的对细菌无活性的抗菌治疗。ABR 结果基于药敏试验和当地医疗机构的报告。采用多变量分析确定与任何阳性细菌培养和 ABR 阳性培养（包括多药耐药菌）相关的 IET 风险因素。
在 269 家医院的 278344 名合格患者中，有 56733 名（20.4%）接受了 IET；ABR 阳性（n=93252）或 MDR 阳性（n=39000）培养的患者中 IET 率更高（分别为 34.9%和 45.0%）。与 SARS-CoV-2 阴性（20.3%）或未检测（19.7%）患者相比，SARS-CoV-2 阳性患者的 IET 率显著更高（25.9%），且在 ABR 和 MDR 亚组中也是如此。ABR 或 MDR 阳性培养的患者接受治疗的天数和住院时间更长。多变量分析显示，ABR、MDR、SARS-CoV-2 阳性状态、呼吸道来源和既往住院是 IET 的关键风险因素。
在 COVID-19 大流行期间，IET 仍然是一个持续存在的问题，且在 ABR/MDR 细菌或合并 SARS-CoV-2 感染的患者中发生率更高。
