Kopp-Derouet A, Diamantis S, Chevret S, Tazi A, Burlacu R, Kevorkian J P, Julla J B, Molina J M, Sellier P
Infectious Diseases Department, Hôpitaux Saint-Louis/Lariboisière, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France.
Université de Paris Cité, Paris, France.
J Antimicrob Chemother. 2024 Dec 2;79(12):3243-3247. doi: 10.1093/jac/dkae350.
During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical.
We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations.
Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively).
We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.
在新冠疫情的第一波流行期间，肺炎患者早期经验性使用抗生素的比例差异很大。其益处仍属假设。
我们评估了新冠病毒肺炎住院患者入院时经验性使用抗生素的益处。我们纳入了2020年3月1日至4月30日入院的所有成年人，其症状持续时间≤14天，鼻咽部聚合酶链反应（PCR）检测呈阳性或CT扫描高度疑似。主要结局是第28天的死亡率。次要结局包括转入重症监护病房（ICU）、机械通气和住院时间。为处理指示性混杂偏倚，我们采用倾向评分分析，在原始人群和重叠加权人群中表达结局。
在616例分析患者中，402例（65%）接受了抗生素治疗。在第28天，102例患者（17%）死亡，90例（15%）转入ICU，24例（4%）需要机械通气。接受抗生素治疗的患者在加权前死亡率较高，但加权后则不然（比值比分别为2.7，95%置信区间1.5 - 5.0，P<0.001和1.4，95%置信区间0.8 - 2.5，P = 0.28）。抗生素使用对以下方面无益处：加权前后转入ICU的情况（比值比分别为1.3，95%置信区间0.8 - 2.3，P = 0.30和1.1，95%置信区间0.6 - 1.9，P = 0.78）；加权前后机械通气的情况（比值比分别为0.5，95%置信区间0.2 - 1.1，P = 0.079和0.75，95%置信区间0.3 - 2.0，P = 0.55）；以及加权前后住院时间（平均差分别为 - 0.02±0.5天，P = 0.97和0.54±0.75天，P = 0.48）。
我们未发现新冠病毒肺炎住院患者使用抗生素有任何益处。
