omicron优势期与前omicron期合并感染对住院COVID- 19患者抗生素使用影响的差异

Yasushi Murakami, Yasuhiro Nozaki, Mika Morosawa, Masanobu Toyama, Hitoshi Ogashiwa, Takashi Ueda, Kazuhiko Nakajima, Ryoya Tanaka, Yoshio Takesue
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Results Patients during the Omicron period were older and had more comorbidities. The rate of critically ill patients was around 10% in both periods. During the pre-Omicron period, > 90% of hospitalized patients were unvaccinated, whereas 41.8% of patients received a booster dose during the Omicron period. Ground-glass opacities, bilateral shadows, and a peripheral distribution on CT were observed in most patients in the pre-Omicron period and there were significant differences in comparison with the Omicron period. Although only 0.9% of patients had bacterial coinfection on admission in the pre-Omicron period, 38.9% of patients had the coinfection during the Omicron period and were less likely to receive COVID-19-directed therapy. Coinfection before /after admission was an independent risk factor for composite adverse events in both periods (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.13–12.59, and OR 9.15, 95% CI 3.85–21.74). DOT in antibiotics for CAIs were significantly fewer in the COVID-19 ward than in general wards in the pre-Omicron period but increased in the Omicron period (from 3.60 ± 3.15 to 17.83 ± 10.00). Numerically lower DOT of antibiotics for HAIs was demonstrated in the COVID-19 ward than in the general wards (pre-Omicron, 3.33 ± 6.09 versus 6.37 ± 1.10; Omicron, 3.84 ± 2.93 versus 5.22 ± 0.79). No MDR gram-negative organisms were isolated in the COVID-19 ward. Conclusions Antibiotic use on admission was limited in the pre-Omicron period but increased in the Omicron period because of a high coinfection rate on admission. 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摘要

背景2019冠状病毒病(COVID-19)患者过度使用抗生素可导致多药耐药(MDR)细菌增加。本研究评估了COVID-19大流行期间的抗生素管理。方法比较2022年Omicron变异流行(n = 225)和2021年既往变异流行(n = 257)期间某社区医院COVID-19患者的抗生素使用情况。抗生素被分类为主要用于社区获得性感染(CAIs)的抗生素和主要用于卫生保健相关感染(HAIs)的抗生素,并评估每100个床位日的治疗天数(DOT)。结果欧米克隆期患者年龄较大,合并症较多。两个时期危重病人的比例都在10%左右。在前欧米克隆时期,>90%的住院患者未接种疫苗,而41.8%的患者在欧米克隆期间接受了加强剂量。多数患者在前Omicron期CT表现为磨玻璃影、双侧阴影、周围分布,与Omicron期比较差异有统计学意义。虽然入院时仅有0.9%的患者在“欧米克隆”前出现了细菌合并感染,但在“欧米克隆”期间,38.9%的患者出现了细菌合并感染,接受针对covid -19的治疗的可能性较小。入院前/入院后合并感染是两期复合不良事件的独立危险因素(优势比[OR] 3.77, 95%可信区间[CI] 1.13-12.59,优势比[OR] 9.15, 95% CI 3.85-21.74)。冠状病毒病区CAIs抗生素使用DOT在预Omicron期明显低于普通病区,但在Omicron期有所增加(从3.60±3.15增加到17.83±10.00)。COVID-19病房的抗生素DOT数值低于普通病房(omicron前,3.33±6.09 vs 6.37±1.10;欧米克隆,3.84±2.93比5.22±0.79)。COVID-19病房未分离到耐多药革兰氏阴性菌。结论入院时抗生素的使用在欧米克隆前是有限的,但在欧米克隆期间由于入院时合并感染率较高而增加。在这两个时期都避免了对艾滋病患者过度使用抗生素。
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Difference in impact of coinfections on antibiotic use in patients hospitalized with COVID- 19 between the Omicron-dominant period and the pre-Omicron period
Abstract Background Excessive antibiotic use in patients with coronavirus disease 2019 (COVID-19) can cause an increase in multidrug-resistant (MDR) organisms. This study evaluated antibiotic stewardship during the COVID-19 pandemic. Methods Antibiotic use in patients with COVID-19 was compared in a community hospital between 2022 when the Omicron variant was prevalent (n = 225) and 2021 when previous variants were prevalent (n = 257). Antibiotics were categorized as antibiotics predominantly used for community-acquired infections (CAIs) and antibiotics predominantly used for health care-associated infections (HAIs), and days of therapy per 100 bed days (DOT) was evaluated. Results Patients during the Omicron period were older and had more comorbidities. The rate of critically ill patients was around 10% in both periods. During the pre-Omicron period, > 90% of hospitalized patients were unvaccinated, whereas 41.8% of patients received a booster dose during the Omicron period. Ground-glass opacities, bilateral shadows, and a peripheral distribution on CT were observed in most patients in the pre-Omicron period and there were significant differences in comparison with the Omicron period. Although only 0.9% of patients had bacterial coinfection on admission in the pre-Omicron period, 38.9% of patients had the coinfection during the Omicron period and were less likely to receive COVID-19-directed therapy. Coinfection before /after admission was an independent risk factor for composite adverse events in both periods (odds ratio [OR] 3.77, 95% confidence interval [CI] 1.13–12.59, and OR 9.15, 95% CI 3.85–21.74). DOT in antibiotics for CAIs were significantly fewer in the COVID-19 ward than in general wards in the pre-Omicron period but increased in the Omicron period (from 3.60 ± 3.15 to 17.83 ± 10.00). Numerically lower DOT of antibiotics for HAIs was demonstrated in the COVID-19 ward than in the general wards (pre-Omicron, 3.33 ± 6.09 versus 6.37 ± 1.10; Omicron, 3.84 ± 2.93 versus 5.22 ± 0.79). No MDR gram-negative organisms were isolated in the COVID-19 ward. Conclusions Antibiotic use on admission was limited in the pre-Omicron period but increased in the Omicron period because of a high coinfection rate on admission. Excessive use of antibiotics for HAIs was avoided during both periods.
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