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Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?

Background: COVID-19 imposes challenges in antibiotic decision-making due to similarities between bacterial pneumonia and moderate to severe COVID-19. We evaluated the effects of antibiotic therapy on the clinical outcomes of COVID-19 pneumonia patients and diagnostic accuracy of key inflammatory ma...

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Autores principales: Ng, Tat Ming, Ong, Sean W. X., Loo, Audrey Y. X., Tan, Sock Hoon, Tay, Hui Lin, Yap, Min Yi, Lye, David C., Lee, Tau Hong, Young, Barnaby E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868256/
https://www.ncbi.nlm.nih.gov/pubmed/35203787
http://dx.doi.org/10.3390/antibiotics11020184
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author Ng, Tat Ming
Ong, Sean W. X.
Loo, Audrey Y. X.
Tan, Sock Hoon
Tay, Hui Lin
Yap, Min Yi
Lye, David C.
Lee, Tau Hong
Young, Barnaby E.
author_facet Ng, Tat Ming
Ong, Sean W. X.
Loo, Audrey Y. X.
Tan, Sock Hoon
Tay, Hui Lin
Yap, Min Yi
Lye, David C.
Lee, Tau Hong
Young, Barnaby E.
author_sort Ng, Tat Ming
collection PubMed
description Background: COVID-19 imposes challenges in antibiotic decision-making due to similarities between bacterial pneumonia and moderate to severe COVID-19. We evaluated the effects of antibiotic therapy on the clinical outcomes of COVID-19 pneumonia patients and diagnostic accuracy of key inflammatory markers to inform antibiotic decision-making. Methods: An observational cohort study was conducted in patients hospitalised with COVID-19 at the National Centre for Infectious Diseases and Tan Tock Seng Hospital, Singapore, from January to April 2020. Patients were defined as receiving empiric antibiotic treatment for COVID-19 if started within 3 days of diagnosis. Results: Of 717 patients included, 86 (12.0%) were treated with antibiotics and 26 (3.6%) had documented bacterial infections. Among 278 patients with COVID-19 pneumonia, those treated with antibiotics had more diarrhoea (26, 34.7% vs. 24, 11.8%, p < 0.01), while subsequent admissions to the intensive care unit were not lower (6, 8.0% vs. 10, 4.9% p = 0.384). Antibiotic treatment was not independently associated with lower 30-day (adjusted odds ratio, aOR 19.528, 95% confidence interval, CI 1.039–367.021) or in-hospital mortality (aOR 3.870, 95% CI 0.433–34.625) rates after adjusting for age, co-morbidities and severity of COVID-19 illness. Compared to white cell count and procalcitonin level, the C-reactive protein level had the best diagnostic accuracy for documented bacterial infections (area under the curve, AUC of 0.822). However, the sensitivity and specificity were less than 90%. Conclusion: Empiric antibiotic use in those presenting with COVID-19 pneumonia did not prevent deterioration or mortality. More studies are needed to evaluate strategies to diagnose bacterial co-infections in these patients.
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spelling pubmed-88682562022-02-25 Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When? Ng, Tat Ming Ong, Sean W. X. Loo, Audrey Y. X. Tan, Sock Hoon Tay, Hui Lin Yap, Min Yi Lye, David C. Lee, Tau Hong Young, Barnaby E. Antibiotics (Basel) Article Background: COVID-19 imposes challenges in antibiotic decision-making due to similarities between bacterial pneumonia and moderate to severe COVID-19. We evaluated the effects of antibiotic therapy on the clinical outcomes of COVID-19 pneumonia patients and diagnostic accuracy of key inflammatory markers to inform antibiotic decision-making. Methods: An observational cohort study was conducted in patients hospitalised with COVID-19 at the National Centre for Infectious Diseases and Tan Tock Seng Hospital, Singapore, from January to April 2020. Patients were defined as receiving empiric antibiotic treatment for COVID-19 if started within 3 days of diagnosis. Results: Of 717 patients included, 86 (12.0%) were treated with antibiotics and 26 (3.6%) had documented bacterial infections. Among 278 patients with COVID-19 pneumonia, those treated with antibiotics had more diarrhoea (26, 34.7% vs. 24, 11.8%, p < 0.01), while subsequent admissions to the intensive care unit were not lower (6, 8.0% vs. 10, 4.9% p = 0.384). Antibiotic treatment was not independently associated with lower 30-day (adjusted odds ratio, aOR 19.528, 95% confidence interval, CI 1.039–367.021) or in-hospital mortality (aOR 3.870, 95% CI 0.433–34.625) rates after adjusting for age, co-morbidities and severity of COVID-19 illness. Compared to white cell count and procalcitonin level, the C-reactive protein level had the best diagnostic accuracy for documented bacterial infections (area under the curve, AUC of 0.822). However, the sensitivity and specificity were less than 90%. Conclusion: Empiric antibiotic use in those presenting with COVID-19 pneumonia did not prevent deterioration or mortality. More studies are needed to evaluate strategies to diagnose bacterial co-infections in these patients. MDPI 2022-01-31 /pmc/articles/PMC8868256/ /pubmed/35203787 http://dx.doi.org/10.3390/antibiotics11020184 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ng, Tat Ming
Ong, Sean W. X.
Loo, Audrey Y. X.
Tan, Sock Hoon
Tay, Hui Lin
Yap, Min Yi
Lye, David C.
Lee, Tau Hong
Young, Barnaby E.
Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?
title Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?
title_full Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?
title_fullStr Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?
title_full_unstemmed Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?
title_short Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?
title_sort antibiotic therapy in the treatment of covid-19 pneumonia: who and when?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868256/
https://www.ncbi.nlm.nih.gov/pubmed/35203787
http://dx.doi.org/10.3390/antibiotics11020184
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