苏格兰医院疑似和确诊 COVID-19 患者的抗生素和抗真菌药物处方调查。
Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals.
机构信息
Infection unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK; Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 48 West Nile Street, Glasgow G1 2NP, UK.
National ARHAI Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, UK.
出版信息
J Infect. 2020 Dec;81(6):952-960. doi: 10.1016/j.jinf.2020.09.024. Epub 2020 Sep 26.
BACKGROUND
Concern regarding bacterial co-infection complicating SARS-CoV-2 has created a challenge for antimicrobial stewardship. Following introduction of national antibiotic recommendations for suspected bacterial respiratory tract infection complicating COVID-19, a point prevalence survey of prescribing was conducted across acute hospitals in Scotland.
METHODS
Patients in designated COVID-19 units were included and demographic, clinical and antimicrobial data were collected from 15 hospitals on a single day between 20th and 30th April 2020. Comparisons were made between SARS-CoV-2 positive and negative patients and patients on non-critical care and critical care units. Factors associated with antibiotic prescribing in SARS-CoV-2 positive patients were examined using Univariable and multivariable regression analyses.
FINDINGS
There were 820 patients were included, 64.8% were SARS-CoV-2 positive and 14.9% were managed in critical care, and 22.1% of SARS-CoV-2 infections were considered probable or definite nosocomial infections. On the survey day, antibiotic prevalence was 45.0% and 73.9% were prescribed for suspected respiratory tract infection. Amoxicillin, doxycycline and co-amoxiclav accounted for over half of all antibiotics in non-critical care wards and meropenem, piperacillin-tazobactam and co-amoxiclav accounted for approximately half prescribed in critical care. Of all SARS-CoV-2 patients, 38.3% were prescribed antibiotics. In a multivariable logistic regression analysis, COPD/chronic lung disease and CRP ≥ 100 mg/l were associated with higher odds and probable or confirmed nosocomial COVID-19, diabetes and management on an elderly care ward had lower odds of an antibiotic prescription. Systemic antifungals were prescribed in 9.8% of critical care patients and commenced a median of 18 days after critical care admission.
INTERPRETATION
A relatively low prevalence of antibiotic prescribing in SARS-CoV-2 hospitalised patients and low proportion of broad spectrum antibiotics in non-critical care settings was observed potentially reflecting national antimicrobial stewardship initiatives. Broad spectrum antibiotic and antifungal prescribing in critical care units was observed indicating the importance of infection prevention and control and stewardship initiatives in this setting.
FUNDING
The Scottish Antibiotic Prescribing Group is funded by Scottish Government.
背景
人们对 SARS-CoV-2 合并细菌感染的担忧给抗菌药物管理带来了挑战。在为 COVID-19 合并疑似细菌性呼吸道感染制定国家抗生素推荐方案后，在苏格兰的急性医院进行了一次针对处方的现况调查。
方法
在指定的 COVID-19 病房中纳入患者，并在 2020 年 4 月 20 日至 30 日之间的一天从 15 家医院收集人口统计学、临床和抗菌药物数据。将 SARS-CoV-2 阳性和阴性患者以及非重症监护病房和重症监护病房的患者进行比较。使用单变量和多变量回归分析检查 SARS-CoV-2 阳性患者中与抗生素使用相关的因素。
结果
共纳入 820 例患者，其中 64.8%为 SARS-CoV-2 阳性，14.9%在重症监护病房治疗，22.1%的 SARS-CoV-2 感染被认为是疑似医院获得性感染。在调查当天，抗生素的使用率为 45.0%，其中 73.9%用于疑似呼吸道感染。非重症监护病房使用的抗生素中，阿莫西林、多西环素和复方阿莫西林占比超过一半，重症监护病房使用的抗生素中，美罗培南、哌拉西林他唑巴坦和复方阿莫西林各占一半左右。所有 SARS-CoV-2 患者中，有 38.3%接受了抗生素治疗。在多变量逻辑回归分析中，COPD/慢性肺部疾病和 CRP≥100mg/L 与更高的抗生素使用几率相关，而疑似或确诊的医院获得性 COVID-19、糖尿病和老年病房管理与抗生素使用几率较低相关。9.8%的重症监护病房患者使用了全身性抗真菌药物，在进入重症监护病房后中位数 18 天开始使用。
解释
在 SARS-CoV-2 住院患者中，抗生素的使用比例相对较低，非重症监护病房使用的广谱抗生素比例也较低，这可能反映了国家抗菌药物管理计划。重症监护病房广谱抗生素和抗真菌药物的使用表明，在这种情况下，感染预防和控制以及管理计划非常重要。
资助
苏格兰抗生素处方小组由苏格兰政府资助。
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