Characterization of antimicrobial use and co-infections among hospitalized patients with COVID-19: a prospective observational cohort study
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Characterization of antimicrobial use and co-infections among hospitalized patients with COVID-19: a prospective observational cohort study. / Lingscheid, Tilman; Lippert, Lena J; Hillus, David; Kruis, Tassilo; Thibeault, Charlotte; Helbig, Elisa T; Tober-Lau, Pinkus; Pfäfflin, Frieder; Müller-Redetzky, Holger; Witzenrath, Martin; Zoller, Thomas; Uhrig, Alexander; Opitz, Bastian; Suttorp, Norbert; Kramer, Tobias S; Sander, Leif E; Stegemann, Miriam S; Kurth, Florian.
in: INFECTION, Jahrgang 50, Nr. 6, 12.2022, S. 1441-1452.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Characterization of antimicrobial use and co-infections among hospitalized patients with COVID-19: a prospective observational cohort study
AU - Lingscheid, Tilman
AU - Lippert, Lena J
AU - Hillus, David
AU - Kruis, Tassilo
AU - Thibeault, Charlotte
AU - Helbig, Elisa T
AU - Tober-Lau, Pinkus
AU - Pfäfflin, Frieder
AU - Müller-Redetzky, Holger
AU - Witzenrath, Martin
AU - Zoller, Thomas
AU - Uhrig, Alexander
AU - Opitz, Bastian
AU - Suttorp, Norbert
AU - Kramer, Tobias S
AU - Sander, Leif E
AU - Stegemann, Miriam S
AU - Kurth, Florian
N1 - © 2022. The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - PURPOSE: To investigate antimicrobial use and primary and nosocomial infections in hospitalized COVID-19 patients to provide data for guidance of antimicrobial therapy.METHODS: Prospective observational cohort study conducted at Charité-Universitätsmedizin Berlin, including patients hospitalized with SARS-CoV-2-infection between March and November 2020.RESULTS: 309 patients were included, 231 directly admitted and 78 transferred from other centres. Antimicrobial therapy was initiated in 62/231 (26.8%) of directly admitted and in 44/78 (56.4%) of transferred patients. The rate of microbiologically confirmed primary co-infections was 4.8% (11/231). Although elevated in most COVID-19 patients, C-reactive protein and procalcitonin levels were higher in patients with primary co-infections than in those without (median CRP 110 mg/l, IQR 51-222 vs. 36, IQR 11-101, respectively; p < 0.0001). Nosocomial bloodstream and respiratory infections occurred in 47/309 (15.2%) and 91/309 (29.4%) of patients, respectively, and were associated with need for invasive mechanical ventilation (OR 45.6 95%CI 13.7-151.8 and 104.6 95%CI 41.5-263.5, respectively), extracorporeal membrane oxygenation (OR 14.3 95%CI 6.5-31.5 and 16.5 95%CI 6.5-41.6, respectively), and haemodialysis (OR 31.4 95%CI 13.9-71.2 and OR 22.3 95%CI 11.2-44.2, respectively). The event of any nosocomial infection was significantly associated with in-hospital death (33/99 (33.3%) with nosocomial infection vs. 23/210 (10.9%) without, OR 4.1 95%CI 2.2-7.3).CONCLUSIONS: Primary co-infections are rare, yet antimicrobial use was frequent, mostly based on clinical worsening and elevated inflammation markers without clear evidence for co-infection. More reliable diagnostic prospects may help to reduce overtreatment. Rates of nosocomial infections are substantial in severely ill patients on organ support and associated with worse patient outcome.
AB - PURPOSE: To investigate antimicrobial use and primary and nosocomial infections in hospitalized COVID-19 patients to provide data for guidance of antimicrobial therapy.METHODS: Prospective observational cohort study conducted at Charité-Universitätsmedizin Berlin, including patients hospitalized with SARS-CoV-2-infection between March and November 2020.RESULTS: 309 patients were included, 231 directly admitted and 78 transferred from other centres. Antimicrobial therapy was initiated in 62/231 (26.8%) of directly admitted and in 44/78 (56.4%) of transferred patients. The rate of microbiologically confirmed primary co-infections was 4.8% (11/231). Although elevated in most COVID-19 patients, C-reactive protein and procalcitonin levels were higher in patients with primary co-infections than in those without (median CRP 110 mg/l, IQR 51-222 vs. 36, IQR 11-101, respectively; p < 0.0001). Nosocomial bloodstream and respiratory infections occurred in 47/309 (15.2%) and 91/309 (29.4%) of patients, respectively, and were associated with need for invasive mechanical ventilation (OR 45.6 95%CI 13.7-151.8 and 104.6 95%CI 41.5-263.5, respectively), extracorporeal membrane oxygenation (OR 14.3 95%CI 6.5-31.5 and 16.5 95%CI 6.5-41.6, respectively), and haemodialysis (OR 31.4 95%CI 13.9-71.2 and OR 22.3 95%CI 11.2-44.2, respectively). The event of any nosocomial infection was significantly associated with in-hospital death (33/99 (33.3%) with nosocomial infection vs. 23/210 (10.9%) without, OR 4.1 95%CI 2.2-7.3).CONCLUSIONS: Primary co-infections are rare, yet antimicrobial use was frequent, mostly based on clinical worsening and elevated inflammation markers without clear evidence for co-infection. More reliable diagnostic prospects may help to reduce overtreatment. Rates of nosocomial infections are substantial in severely ill patients on organ support and associated with worse patient outcome.
KW - Humans
KW - COVID-19/epidemiology
KW - Coinfection/drug therapy
KW - SARS-CoV-2
KW - Hospital Mortality
KW - Prospective Studies
KW - Anti-Infective Agents/therapeutic use
KW - Cross Infection/drug therapy
KW - COVID-19 Drug Treatment
U2 - 10.1007/s15010-022-01796-w
DO - 10.1007/s15010-022-01796-w
M3 - SCORING: Journal article
C2 - 35420370
VL - 50
SP - 1441
EP - 1452
JO - INFECTION
JF - INFECTION
SN - 0300-8126
IS - 6
ER -
