Shappell Claire N, Klompas Michael, Chan Christina, Chen Tom, Rhee Chanu
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Oct 3;4(1):e143. doi: 10.1017/ash.2024.366. eCollection 2024.
To assess trends in antibiotic prescribing for patients hospitalized with COVID-19 with and without sepsis.
Retrospective cohort study using electronic health record (EHR) data.
Five hospitals in eastern Massachusetts.
Adults (≥18 years) hospitalized with community-onset SARS-CoV-2 infections between March 2020 and November 2022.
We assessed quarterly trends in the use of prolonged initial antibiotic therapy (≥4 antibiotic days within one week of admission, including discharge antibiotics) amongst COVID-19 patients with and without sepsis, defined using clinical signs of organ dysfunction before hospital day 3. Poisson regression models were used to adjust for baseline characteristics and severity of illness.
Of 431,017 hospitalizations in the study period, 21,563 (5.0%) had community-onset COVID-19. 4,769/21,563 (20.5%) presented with sepsis. Prolonged antibiotics were prescribed in 2,323/4,769 (48.7%) COVID-19 patients with sepsis and 2,866/16,794 (17.1%) without sepsis despite low rates of positive bacterial cultures on admission (15.0% vs 6.3%, respectively). Quarterly rates of prolonged antibiotics declined between the first and second pandemic quarters for both sepsis (66.8% to 43.9%) and no-sepsis (31.8% to 24.4%) groups. However, there was no significant change thereafter through November 2022 in either group (quarterly aORs 1.02, 95% CI 0.99-1.05 and 1.01, 95% CI 0.99-1.03, respectively).
Prolonged antibiotics were common in hospitalized COVID-19 patients with and without sepsis during the first 33 months of the pandemic despite low rates of proven bacterial infection. Decreases in antibiotic utilization occurred primarily between the first and second pandemic quarter with no further reduction thereafter.
评估合并或未合并脓毒症的新冠肺炎住院患者抗生素处方的趋势。
使用电子健康记录（EHR）数据进行回顾性队列研究。
马萨诸塞州东部的五家医院。
2020年3月至2022年11月期间因社区获得性SARS-CoV-2感染住院的成年人（≥18岁）。
我们评估了合并或未合并脓毒症的新冠肺炎患者长期初始抗生素治疗（入院一周内使用抗生素≥4天，包括出院时使用的抗生素）的季度趋势，脓毒症定义为入院第3天前出现器官功能障碍的临床体征。采用泊松回归模型对基线特征和疾病严重程度进行校正。
在研究期间的431,017次住院中，21,563例（5.0%）为社区获得性新冠肺炎。4,769/21,563例（20.5%）出现脓毒症。尽管入院时细菌培养阳性率较低（分别为15.0%和6.3%），但2,323/4,769例（48.7%）合并脓毒症的新冠肺炎患者和2,866/16,794例（17.1%）未合并脓毒症的患者接受了长期抗生素治疗。脓毒症组和非脓毒症组在大流行的第一季度和第二季度之间，长期抗生素的季度使用率均有所下降（分别从66.8%降至43.9%和从31.8%降至24.4%）。然而，此后至2022年11月，两组均无显著变化（季度调整后比值比分别为1.02，95%置信区间0.99-1.05和1.01，95%置信区间0.99-1.03）。
在大流行的前33个月里，无论是否合并脓毒症，住院的新冠肺炎患者中使用长期抗生素的情况都很常见，尽管确诊细菌感染的比例较低。抗生素使用量的下降主要发生在大流行的第一季度和第二季度之间，此后没有进一步下降。
