BMC Infectious Diseases最新文献

In early 2020, no drug had proven efficacy to treat COVID-19 in-patients. This work aimed to describe COVID-19 treatment for in-patients worldwide until June, 2020. A PubMed search was performed with the terms "retrospective observational study", "hospital", "treatment" and "COVID" to identify English-written studies describing treatments given to adult in-patients before June 30, 2020. The identified reports were analyzed, with data extracted regarding patient characteristics and treatments across continents and countries. Overall, 178 studies involving 181,510 patients in 28 countries were analyzed, including 484 patients from Africa, 36,840 from Asia, 69,088 from Europa and 68,524 from North America. The most prescribed drugs were hydroxychloroquine (64.3%, i.e. 41.9% of all patients), corticosteroids (31.0%, i.e. 21.0%) and lopinavir/ritonavir (30.8%, i.e. 12.0%). Corticosteroids was used worldwide with similar rates in Asia, Europe and North America. Hydroxychloroquine dominated prescriptions in Africa, Europe and North America. Asia exhibited unique features: less frequent hydroxychloroquine use, higher oseltamivir use and exclusive use of umifenovir. In Europe, repurposed drugs prescription was the highest in Spain and Italy. Our study is not an exhaustive review of the literature on COVID-19 treatment of in-patients early in 2020 but is the first one to provide a comprehensive overview of COVID-19 treatment modalities in such a broad range of countries worldwide. Our work reveals high prescription rates but also heterogeneity across continents and countries in the treatment of COVID-19 in-patients worldwide. These findings emphasize the critical role of international collaboration in generating and disseminating reliable information for managing emerging diseases.

Background: Pneumonia is a common and severe complication following spontaneous intracerebral hemorrhage (SICH) and is associated with significantly worse clinical outcomes. However, there remains insufficient evidence supporting empirical antibiotic regimens for SICH-associated pneumonia (SICHAP).

Objective: To evaluate the clinical efficacy of different empirical antibiotic regimens in patients with SICHAP and to provide evidence for optimizing initial antimicrobial strategies.

Methods: This single-center retrospective cohort study enrolled adult patients with SICH who developed pneumonia within 7 days of onset between July and December 2024. Patients were stratified according to their initial empirical antibiotic regimen: cefazolin (CFZ), ceftriaxone (CRO), cefoperazone-sulbactam (CFP-SUL), or piperacillin-tazobactam (PIP-TAZ). The primary outcome was the clinical efficacy rate at 72 h. The secondary outcomes included the SICHAP treatment failure rate, in-hospital mortality, length of stay, duration of mechanical ventilation, and duration of antibiotic therapy. Treatment appropriateness was assessed on the basis of sputum culture and antimicrobial susceptibility testing.

Results: A total of 85 patients (mean age 54.2 ± 13.5 years, 63.5% male) were enrolled, with 90.6% presenting with early SICHAP. The 72-hour efficacy rate in the CFP-SUL group (73.3%) was significantly greater than that in the CFZ group (25.0%), CRO group (54.5%), and PIP-TAZ group (58.8%) (p = 0.022). The overall SICHAP treatment failure rate was 55.3%, with no significant intergroup differences (p = 0.137). In the sputum culture-positive subgroup (n = 49), appropriate empirical antibiotic therapy (AEAT) significantly reduced treatment failure (58.1% vs. 94.4%, p = 0.008). Pathogens were predominantly Gram-negative (75.3%), with the most common isolates being Klebsiella pneumoniae (42.9%), Pseudomonas aeruginosa (40.8%), and Acinetobacter baumannii (22.4%). High rates of ESBL production and carbapenemase detection were observed.

Conclusion: Among SICHAP patients, empirical CFP-SUL therapy demonstrated greater 72-hour clinical efficacy, and AEATs significantly reduced the risk of treatment failure. These findings suggest that CFP-SUL may be favored for early empirical antimicrobial therapy in this population, although prospective randomized controlled trials are needed to confirm these results.

Clinical trial: Clinical trial number: not applicable.