The discussion concerning use of antibacterial drugs at viral infections, in particular at COVID-19 continues. Though currently time at viral infections most of experts are negative to the idea of prescription of antibiotics, secondary bacterial complications of COVID-19 can be the reason for use of drugs of this group. In this article we will sort whether purpose of antibacterial drugs at an early stage influences mortality from COVID-19.
In recently published article Lansbury L. et al. it was told about existence of the combined bacterial infection at an insignificant share of patients with COVID-19. Nevertheless Huttner B. et al. recommended antibiotics for treatment of the majority of manifestations of a severe form of COVID-19. Number of authors, in particular, Rawson T.M. et al. describe large-scale use of antibacterial drugs of a broad spectrum of activity for treatment of 72% (1450 of 2010) of patients with COVID-19, despite insufficient proofs of existence of the combined bacterial infection. COVID-19 can sometimes imitate bacterial pneumonia therefore for elimination of the possible combined bacterial infection often enter antibiotics. The group of scientists from Switzerland executed a retrospective research which purpose was a description of impact of the antibiotic treatment which is carried out at early stages (i.e., before reception on intensive care unit and an intensive care [ORIT]), on mortality and developing of serious nozokomialny infectious diseases of the delayed character in ORIT.
During the period the retrospective analysis of all medical records of the intubated patients in ORIT which were hospitalized in the hospital allocated for treatment of patients with COVID-19 in the south of Switzerland was made from April 9 to May 20, 2020. This hospital was the referensny center for group of the population in 350’000 people (seven state hospitals). Researchers described patients to whom antibiotics were entered (in comparison with patients to whom antibiotics were not entered) before hospitalization into ORIT, and differences between two groups on rates of mortality, emergence the fan-the associated pneumonia (FAP), a catheter - the connected infections of a blood-groove (CRBSI), the infections of urinary tract (IUT) and a kandidemiya (i.e. on outcomes are analysed). It is important that antibiotics before hospitalization were entered into ORIT to the discretion of the attending physician.
Thus, authors of work included in a research of 48 patients from COVID-19 which are in ORIT. Average age of patients was 66.5 years and 33% of patients (11 people) were women. Antibiotics before hospitalization in ORIT were entered into 40% (19 people) of cases, and in all cases suspicion of the combined bacterial infection was the clinical indication. Amoxicillin/clavulanate (68%, 13 people) was the most often used antibiotic.
In general, as authors consider, characteristics of patients of both groups were identical. At patients to whom antibiotics were not entered cardiovascular diseases met more often (38% against 16% of patients which entered antibiotics, p=0.12); women (32% against 17% in group of patients to whom antibiotics were not entered of p=0.25) and antiviral drugs (68% against 48%, p=0.17) met more often in group of patients to whom antibiotics were entered. Rates of mortality were similar in two groups (24% in group of patients to whom antibiotics against 26% in group of patients to whom antibiotics, p=0.86 were entered were not entered). It is remarkable that groups did not differ on number of nozokomialny infectious diseases of the delayed character for the time spent in ORIT. Infections of uric ways met more often in group of patients to whom antibiotics while the kandidemiya arose more often in group of patients to whom antibiotics were entered were not entered.
The small number of patients concerning whom was executed a research, the analysis, does not allow to draw an unambiguous conclusion, but nevertheless the preliminary results received by authors show that introduction of antibiotics at early stages, obviously, does not make considerable impact on rate of mortality or developing of nozokomialny infections of the delayed character at critical and sick patients. It calls into question expediency of early therapy of expected bacterial superinfection at patients with COVID-19. Authors consider that carrying out large-scale multicenter researches is urgently necessary for definition of impact of early antibiotic treatment on mortality and the subsequent developing of nozokomialny infections and complications in ORIT.