The Effect of Antibiotic Use on Transfer to Intensive Care Unit in COVID-19 Patients with Possible Secondary Bacterial Pneumonia: A Retrospective Cohort Study

Ahmet Sertçelik; Ümran Özden Sertçelik; Bircan Kayaaslan; Hatice Kılıç; Rahmet Güner

Makale detayları

The Effect of Antibiotic Use on Transfer to Intensive Care Unit in COVID-19 Patients with Possible Secondary Bacterial Pneumonia: A Retrospective Cohort Study

Yazarlar:

Ahmet Sertçelik | Ümran Özden Sertçelik | Bircan Kayaaslan | Hatice Kılıç | Rahmet Güner

Yayıncı:

Hitit University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Hitit Medical Journal Vol.5 Issue 3, pp.162-169

Belge Tipi:

Makale

Yayın Tarihi:

10/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001300834

pISSN:

2687-4717

Anahtar kelimeler:

Özet:

 Objective: We aimed to determine the frequency of antibiotics use for possible secondary bacterial pneumonia among hospitalized COVID-19 adults and its association with transfer to intensive care unit ICU. Material and Method: Hospitalized COVID-19 adults of a tertiary hospital followed retrospectively from 10 March through 31 December 2020, for possible secondary bacterial pneumonia and their transfer to ICU if any. Patients with bacterial infections other than pneumonia were excluded. Possible bacterial pneumonia was defined as imaging compatible with bacterial pneumonia, together with at least one of cough sputum, body temperature above 37C, leukocyte count over 10000μL andor procalcitonin level over 0.16μgL. Results: Of the 724 eligibles, nine patients with a bacterial infection other than pneumonia were excluded, leaving 715 for analyses. Over a median of 7 IQR6 days of follow-up, 462 64.6 of the patients received antibiotics, while 25335.4 did not. Thirty-three 7.1 of the patients receiving antibiotics were transferred to ICU, compared to 26 10.3 out of those who did not receive antibiotics: the risk of ICU was 0.70 95CI0.431.14. In logistic regression analysis, transfer to ICU was lower, yet not statistically significant, among antibiotic receivers 0.56; 95CI0.301.03, adjusting for age, gender, comorbidity, COVID-19 severity, use of favipiravir, azithromycin, and hydroxychloroquine. Conclusion: Antbiotic use did not statistically significantly affect transfer to ICU. Prospective cohorts are warranted for conclusive evidence to discard the potential for type 2 errors or ineffectiveness of ampiric treatment due to amtimicrobial resistance, and to further validate diagnostic criteria and appropriateness of ampiric regimens.

 Objective: We aimed to determine the frequency of antibiotics use for possible secondary bacterial pneumonia among hospitalized COVID-19 adults and its association with transfer to intensive care unit ICU. Material and Method: Hospitalized COVID-19 adults of a tertiary hospital followed retrospectively from 10 March through 31 December 2020, for possible secondary bacterial pneumonia and their transfer to ICU if any. Patients with bacterial infections other than pneumonia were excluded. Possible bacterial pneumonia was defined as imaging compatible with bacterial pneumonia, together with at least one of cough sputum, body temperature above 37C, leukocyte count over 10000μL andor procalcitonin level over 0.16μgL. Results: Of the 724 eligibles, nine patients with a bacterial infection other than pneumonia were excluded, leaving 715 for analyses. Over a median of 7 IQR6 days of follow-up, 462 64.6 of the patients received antibiotics, while 25335.4 did not. Thirty-three 7.1 of the patients receiving antibiotics were transferred to ICU, compared to 26 10.3 out of those who did not receive antibiotics: the risk of ICU was 0.70 95CI0.431.14. In logistic regression analysis, transfer to ICU was lower, yet not statistically significant, among antibiotic receivers 0.56; 95CI0.301.03, adjusting for age, gender, comorbidity, COVID-19 severity, use of favipiravir, azithromycin, and hydroxychloroquine. Conclusion: Antbiotic use did not statistically significantly affect transfer to ICU. Prospective cohorts are warranted for conclusive evidence to discard the potential for type 2 errors or ineffectiveness of ampiric treatment due to amtimicrobial resistance, and to further validate diagnostic criteria and appropriateness of ampiric regimens.

 Objective: We aimed to determine the frequency of antibiotics use for possible secondary bacterial pneumonia among hospitalized COVID-19 adults and its association with transfer to intensive care unit ICU. Material and Method: Hospitalized COVID-19 adults of a tertiary hospital followed retrospectively from 10 March through 31 December 2020, for possible secondary bacterial pneumonia and their transfer to ICU if any. Patients with bacterial infections other than pneumonia were excluded. Possible bacterial pneumonia was defined as imaging compatible with bacterial pneumonia, together with at least one of cough sputum, body temperature above 37C, leukocyte count over 10000μL andor procalcitonin level over 0.16μgL. Results: Of the 724 eligibles, nine patients with a bacterial infection other than pneumonia were excluded, leaving 715 for analyses. Over a median of 7 IQR6 days of follow-up, 462 64.6 of the patients received antibiotics, while 25335.4 did not. Thirty-three 7.1 of the patients receiving antibiotics were transferred to ICU, compared to 26 10.3 out of those who did not receive antibiotics: the risk of ICU was 0.70 95CI0.431.14. In logistic regression analysis, transfer to ICU was lower, yet not statistically significant, among antibiotic receivers 0.56; 95CI0.301.03, adjusting for age, gender, comorbidity, COVID-19 severity, use of favipiravir, azithromycin, and hydroxychloroquine. Conclusion: Antbiotic use did not statistically significantly affect transfer to ICU. Prospective cohorts are warranted for conclusive evidence to discard the potential for type 2 errors or ineffectiveness of ampiric treatment due to amtimicrobial resistance, and to further validate diagnostic criteria and appropriateness of ampiric regimens.

 Amaç: COVID-19 nedeniyle serviste izlenen ikincil bakteriyel pnömoni olasılığı olan erişkin hastalarda antibiyotik kullanma sıklığı ve bunun yoğun bakıma nakil durumu ile ilişkisinin belirlenmesi amaçlandı. Gereç ve Yöntem: Üçüncü basamak bir hastanede 10.03.2020-31.12.2020 tarihleri arasında COVID-19 hastalığı nedeniyle serviste takip edilen 18 yaş u zeri hastalardan olası ikincil bakteriyel pnömonisi olan hastalar retrospektif olarak incelendi. Pnömoni dışı bakteriyel infeksiyonu olanlar dışlandı. Bu hasta kohortu yoğun bakıma gidiş açısından yatış su releri boyunca izlendi. Olası bakteriyel pnömoni tanısı için hastanın görüntülemede bakteriyel pnömoni ile uyumlu bulgu olması yanı sıra öksu ru k, balgam, 37C üzeri vücut sıcaklığı, 10000μl üzeri lökosit veveya, 0,16μgl üzeri prokalsitonin düzeyinden en az birisinin varlığı arandı. Bulgular: Dahil etme kriterlerine uyan 724 hastadan pnömoni dışında bir bakteriyel infeksiyon odağı olan 9 hasta dışlanmış ve analizler 715 hasta u zerinden tamamlanmıştır. Hastalar ortanca 7 ÇADA6 gün izlenmiş ve hastaların 462si 64,6 antibiyotik alırken, 253u 35,4 almamıştır. Antibiyotik alan hastaların 33u 7,1, almayan hastaların ise 26sı 10,3 izlem süresinde yoğun bakıma nakledilmiş olup, antibiyotik alanlarda almayanlara göre yoğun bakıma gitme rölatif riski 0,70 95 GA  0,43  1,14tir. Lojistik regresyon analizinde yaş, cinsiyet, komorbidite bulunma durumu, ciddi COVID-19 varlığı, favipiravir, azitromisin ve hidroksiklorokin kullanma durumları eş zamanlı kontrol edildiğinde, antibiyotik kullanan hastalarda, kullanmayanlara göre yoğun bakıma nakil du zeltilmiş risk odds oranı koruyucu olsa da istatistiksel olarak anlamlı bulunmamıştır 0,56; 95GA0,30-1,30. En çok tercih edilen antibiyotikler sefalosporinler 42,5, makrolidler 19,2 ve piperasilin-tazobaktam 8,5dır. Sonuç: Antibiyotik kullanmanın yoğun bakıma gidişi önleme konusunda istatistiksel olarak anlamlı bir etkisi bulunmamıştır. Olası tip 2 hata, antimikrobiyal direnç nedeniyle ampirik tedavinin yetersizliği yanı sıra tanı kriterlerinin geçerliliği, uygun antibiyotik seçimi benzeri konuların netleştirilmesi için prospektif kohortlara ihtiyaç vardır.

Makale detayları

The Effect of Antibiotic Use on Transfer to Intensive Care Unit in COVID-19 Patients with Possible Secondary Bacterial Pneumonia: A Retrospective Cohort Study

Yazarlar:

Ahmet Sertçelik | Ümran Özden Sertçelik | Bircan Kayaaslan | Hatice Kılıç | Rahmet Güner

Yayıncı:

Hitit University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Hitit Medical Journal Vol.5 Issue 3, pp.162-169

Belge Tipi:

Makale

Yayın Tarihi:

10/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001300834

pISSN:

2687-4717

2019-nCoV Disease

Anti-Bacterial agents

Bacterial pneumonia

Coinfection

Follow-up studyantibakteriyel ajanlar

bakteriyel pnömoni

izlem

koenfeksiyon

SARS-CoV-2

Sayı

Makale detayları

Yazarlar: Ahmet Sertçelik | Ümran Özden Sertçelik | Bircan Kayaaslan | Hatice Kılıç | Rahmet Güner

Yayıncı: Hitit University

Ana Başlıklar: Klinik Tıp Bilimleri

Dergi: Hitit Medical Journal Vol.5 Issue 3, pp.162-169

Belge Tipi: Makale

Yayın Tarihi: 10/2023

Belge Dili: Türkçe

Document ID (Org No.): 2001300834

pISSN: 2687-4717

Sayı

Yazarlar:

Ahmet Sertçelik | Ümran Özden Sertçelik | Bircan Kayaaslan | Hatice Kılıç | Rahmet Güner

Yayıncı:

Hitit University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Hitit Medical Journal Vol.5 Issue 3, pp.162-169

Belge Tipi:

Makale

Yayın Tarihi:

10/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001300834

pISSN:

2687-4717