细菌和真菌合并感染冠状病毒的个体：一项支持 COVID-19 抗菌药物处方的快速综述。
Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing.
机构信息
National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.
Centre for Antimicrobial Optimisation, Imperial College London, London, United Kingdom.
出版信息
Clin Infect Dis. 2020 Dec 3;71(9):2459-2468. doi: 10.1093/cid/ciaa530.
BACKGROUND
To explore and describe the current literature surrounding bacterial/fungal coinfection in patients with coronavirus infection.
METHODS
MEDLINE, EMBASE, and Web of Science were searched using broad-based search criteria relating to coronavirus and bacterial coinfection. Articles presenting clinical data for patients with coronavirus infection (defined as SARS-1, MERS, SARS-CoV-2, and other coronavirus) and bacterial/fungal coinfection reported in English, Mandarin, or Italian were included. Data describing bacterial/fungal coinfections, treatments, and outcomes were extracted. Secondary analysis of studies reporting antimicrobial prescribing in SARS-CoV-2 even in absence of coinfection was performed.
RESULTS
1007 abstracts were identified. Eighteen full texts reporting bacterial/fungal coinfection were included. Most studies did not identify or report bacterial/fungal coinfection (85/140; 61%). Nine of 18 (50%) studies reported on COVID-19, 5/18 (28%) on SARS-1, 1/18 (6%) on MERS, and 3/18 (17%) on other coronaviruses. For COVID-19, 62/806 (8%) patients were reported as experiencing bacterial/fungal coinfection during hospital admission. Secondary analysis demonstrated wide use of broad-spectrum antibacterials, despite a paucity of evidence for bacterial coinfection. On secondary analysis, 1450/2010 (72%) of patients reported received antimicrobial therapy. No antimicrobial stewardship interventions were described. For non-COVID-19 cases, bacterial/fungal coinfection was reported in 89/815 (11%) of patients. Broad-spectrum antibiotic use was reported.
CONCLUSIONS
Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal coinfection. Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic is urgently required.
背景
探索并描述目前关于冠状病毒感染患者细菌/真菌感染合并感染的文献。
方法
使用广泛的搜索标准，在 MEDLINE、EMBASE 和 Web of Science 中搜索与冠状病毒合并细菌感染相关的文献。纳入以英文、简体中文或意大利文发表的报告冠状病毒感染（定义为 SARS-1、MERS、SARS-CoV-2 和其他冠状病毒）患者临床数据以及细菌/真菌感染合并感染的数据的文章。提取描述细菌/真菌感染合并感染、治疗和结局的数据。对即使无合并感染也报告抗微生物药物使用情况的 SARS-CoV-2 研究进行二次分析。
结果
共确定了 1007 篇摘要。纳入 18 篇报告细菌/真菌感染合并感染的全文。大多数研究未确定或报告细菌/真菌感染（85/140；61%）。18 篇研究中有 9 篇（50%）报告了 COVID-19，5/18（28%）报告了 SARS-1，1/18（6%）报告了 MERS，3/18（17%）报告了其他冠状病毒。对于 COVID-19，806 例患者中有 62 例（8%）在住院期间报告发生细菌/真菌感染。二次分析表明，尽管缺乏细菌合并感染的证据，但广谱抗菌药物的广泛使用。在二次分析中，2010 例患者中有 1450 例（72%）报告接受了抗菌药物治疗。未描述抗菌药物管理干预措施。对于非 COVID-19 病例，815 例患者中有 89 例（11%）报告发生细菌/真菌感染。报告了广谱抗生素的使用。
结论
尽管在冠状病毒相关呼吸道感染患者中频繁使用广谱经验性抗菌药物，但支持与呼吸道细菌/真菌感染合并感染相关的数据很少。迫切需要生成支持针对 COVID-19 大流行制定抗菌药物政策和适当管理干预措施的前瞻性证据。
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