Duan Yishan, Ren Jing, Wang Jing, Wang Suyan, Zhang Rui, Zhang Huohuo, Hu Jinrui, Deng Wen, Li Weimin, Chen Bojiang
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
The Integrated Care Management Center, West China Hospital of Sichuan University, Chengdu, Chengdu, Sichuan Province, 610041, People's Republic of China.
Infect Drug Resist. 2024 Aug 9;17:3425-3438. doi: 10.2147/IDR.S470957. eCollection 2024.
Early empiric antibiotics were prescribed to numerous patients during the Coronavirus disease 2019 (COVID-19) pandemic. However, the potential impact of empiric antibiotic therapy on the clinical outcomes of patients hospitalized with COVID-19 is yet unknown.
In this retrospective cohort study, early antibiotics use cohort was defined as control group, which was compared with no antibiotic use and delayed antibiotic use cohorts for all-cause mortality during hospitalization. The 1:2 propensity score matched patient populations were further developed to adjust confounding factors. Survival curves were compared between different cohorts using a Log rank test to assess the early antibiotic effectiveness.
We included a total of 1472 COVID-19 hospitalized patients, of whom 87.4% (1287 patients) received early antibiotic prescriptions. In propensity-score-matched datasets, our analysis comprised 139 patients with non-antibiotic use (with 278 matched controls) and 27 patients with deferred-antibiotic use (with 54 matched controls). Patients with older ages, multiple comorbidities, severe and critical COVID-19 subtypes, higher serum infection indicators, and inflammatory indicators at admission were more likely to receive early antibiotic prescriptions. After adjusting confounding factors likely to influence the prognosis, there is no significant difference in all-cause mortality (HR=1.000(0.246-4.060), p = 1.000) and ICU admission (HR=0.436(0.093-2.04), p = 0.293), need for mechanical ventilation (HR=0.723(0.296-1.763), p = 0.476) and tracheal intubation (HR=1.338(0.221-8.103), p = 0.751) were observed between early antibiotics use cohort and non-antibiotic use cohort.
Early antibiotics were frequently prescribed to patients in more severe disease condition at admission. However, early antibiotic treatment failed to demonstrate better clinical outcomes in hospitalized patients with COVID-19 in the propensity-score-matched cohorts.
在2019年冠状病毒病（COVID-19）大流行期间，众多患者接受了早期经验性抗生素治疗。然而，经验性抗生素治疗对COVID-19住院患者临床结局的潜在影响尚不清楚。
在这项回顾性队列研究中，将早期使用抗生素的队列定义为对照组，与未使用抗生素和延迟使用抗生素的队列比较住院期间的全因死亡率。进一步构建1:2倾向评分匹配的患者群体以调整混杂因素。使用对数秩检验比较不同队列之间的生存曲线，以评估早期抗生素的有效性。
我们共纳入1472例COVID-19住院患者，其中87.4%（1287例患者）接受了早期抗生素处方。在倾向评分匹配的数据集中，我们的分析包括139例未使用抗生素的患者（有278例匹配对照）和27例延迟使用抗生素的患者（有54例匹配对照）。年龄较大、合并多种疾病、COVID-19亚型为重症和危重症、入院时血清感染指标和炎症指标较高的患者更有可能接受早期抗生素处方。在调整可能影响预后的混杂因素后，早期使用抗生素队列与未使用抗生素队列之间在全因死亡率（HR=1.000(0.246 - 4.060)，p = 1.000）、入住重症监护病房（ICU）（HR=0.436(0.093 - 2.04)，p = 0.293）、需要机械通气（HR=0.723(0.296 - 1.763)，p = 0.476）和气管插管（HR=1.338(0.221 - 8.103)，p = 0.751）方面均未观察到显著差异。
入院时病情较重的患者经常接受早期抗生素治疗。然而，在倾向评分匹配队列中，早期抗生素治疗未能在COVID-19住院患者中显示出更好的临床结局。
