抗生素与 PCT 水平升高的 COVID-19 肺炎患者结局的相关性。
Association of antibiotics with the outcomes in COVID-19 pneumonia patients with elevated PCT levels.
机构信息
Department of Critical Care Medicine, Mayo Clinic in Florida, USA.
Department of Quantitative Health Sciences, Mayo Clinic in Florida, USA.
出版信息
Respir Med. 2024 Sep;231:107697. doi: 10.1016/j.rmed.2024.107697. Epub 2024 Jun 8.
OBJECTIVE
To assess antibiotics impact on outcomes in COVID-19 pneumonia patients with varying procalcitonin (PCT) levels.
METHODS
This retrospective cohort study included 3665 COVID-19 pneumonia patients hospitalized at five Mayo Clinic sites (March 2020 to June 2022). PCT levels were measured at admission. Patients' antibiotics use and outcomes were collected via the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Patients were stratified into high and low PCT groups based on the first available PCT result. The distinction between high and low PCT was demarcated at both 0.25 ng/ml and 0.50 ng/ml.
RESULTS
Our cohort consisted of 3665 patients admitted with COVID-19 pneumonia. The population was predominantly male, Caucasian and non-Hispanic. With the PCT cut-off of 0.25 ng/ml, 2375 (64.8 %) patients had a PCT level <0.25 ng/mL, and 1290 (35.2 %) had PCT ≥0.25 ng/ml. While when the PCT cut off of 0.50 ng/ml was used we observed 2934 (80.05 %) patients with a PCT <0.50 ng/ml while 731(19.94 %) patients had a PCT ≥0.50 ng/ml. Patients with higher PCT levels exhibited significantly higher rates of bacterial infections (0.25 ng/ml cut-off: 4.2 % vs 7.9 %; 0.50 ng/ml cut-off: 4.6 % vs 9.2 %). Antibiotics were used in 66.0 % of the cohort. Regardless of the PCT cutoffs, the antibiotics group showed increased hospital length of stay (LOS), intensive care unit (ICU) admission rate, and mortality. However, early de-escalation (<24 h) of antibiotics correlated with reduced hospital LOS, ICU LOS, and mortality. These results were consistent even after adjusting for confounders.
CONCLUSION
Our study shows a substantial number of COVID-19 pneumonia patients received antibiotics despite a low incidence of bacterial infections. Therefore, antibiotics use in COVID pneumonia patients with PCT <0.5 in the absence of clinical evidence of bacterial infection has no beneficial effect.
目的
评估降钙素原（PCT）水平不同的 COVID-19 肺炎患者使用抗生素对结局的影响。
方法
本回顾性队列研究纳入了 2020 年 3 月至 2022 年 6 月在梅奥诊所五个院区住院的 3665 例 COVID-19 肺炎患者。入院时测定 PCT 水平。通过危重病医学会（SCCM）病毒感染和呼吸道疾病通用研究（VIRUS）登记系统收集患者的抗生素使用和结局数据。根据首次 PCT 结果，将患者分为 PCT 高值组和低值组。基于 PCT 值为 0.25ng/ml 和 0.50ng/ml 分别划定 PCT 高值和低值的界限。
结果
本队列纳入了 3665 例因 COVID-19 肺炎入院的患者。该人群以男性、白人和非西班牙裔为主。以 PCT 截断值为 0.25ng/ml 时，2375（64.8%）例患者的 PCT 值<0.25ng/ml，1290（35.2%）例患者的 PCT 值≥0.25ng/ml。当 PCT 截断值为 0.50ng/ml 时，2934（80.05%）例患者的 PCT 值<0.50ng/ml，731（19.94%）例患者的 PCT 值≥0.50ng/ml。PCT 值较高的患者细菌感染发生率显著较高（0.25ng/ml 截断值：4.2% vs 7.9%；0.50ng/ml 截断值：4.6% vs 9.2%）。该队列中抗生素的使用率为 66.0%。无论 PCT 截断值如何，抗生素组的住院时间（LOS）、入重症监护病房（ICU）率和死亡率均增加。然而，抗生素的早期降级（<24h）与住院 LOS、ICU LOS 和死亡率降低相关。即使在校正混杂因素后，这些结果仍然一致。
结论
本研究表明，尽管细菌感染发生率较低，但仍有大量 COVID-19 肺炎患者接受了抗生素治疗。因此，在没有细菌感染临床证据的情况下，对于 PCT<0.5 的 COVID 肺炎患者使用抗生素没有有益效果。
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