Title Primjena antibiotske terapije u COVID-19 pandemiji : retrospektivno kohortno istraživanje bolesnika KBC-a Split
Title (english) Antibiotic therapy in the COVID-19 pandemic : retrospective cohort study of patients hospitalized at University Hospital of Split
Author Dora Starčević
Mentor Shelly Pranić (mentor)
Committee member Ana Šešelja Perišin (predsjednik povjerenstva)
Committee member Ivana Pavlinac Dodig (član povjerenstva)
Committee member Marija Roguljić (član povjerenstva)
Granter University of Split School of Medicine Split
Defense date and country 2022, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Basic Medical Sciences Pharmacology
Abstract Uvod: Tijekom COVID-19 pandemije učestalost primjene antibiotika globalno se povećala. Najozbiljnija posljedica pretjerane primjene antibiotika jest razvoj multirezistentnih patogena što zahtjeva dugotrajno liječenje uz nepredvidive ishode te izaziva velike troškove unutar zdravstvenog sustava. Ciljevi: Primarni cilj provedenog istraživanja bio je utvrditi učestalost primjene i vrstu antibiotske terapije COVID-19 bolesnika hospitaliziranih u KBC Split. Sekundarni cilj bio je pokazati povezanost primjene antibiotske terapije s komorbiditetima, odabranim laboratorijskim nalazima i smrtnim ishodom.
Ispitanici i postupci: Retrospektivno istraživanje dio je veće multicentrične studije i provedeno je na kohorti od 285 bolesnika hospitaliziranih na Klinici za infektologiju u Splitu tijekom listopada i studenog 2020. godine. Za svakog ispitanika pretraživano je 244 stavki iz otpusnih pisama, a u analizu su uključene varijable: dob i spol ispitanika, broj dana provedenih u bolničkom liječenju, podatci o prethodnom pobolijevanju, primijenjena antibiotska terapija, dijagnosticirana pneumonija, vrijednosti sistoličkog i dijastoličkog arterijskog tlaka te laboratorijski nalazi: vrijednost saturacije periferne krvi kisikom, koncentracija ureje, kreatinina, ukupnog bilirubina, D dimera te udijeli neutrofila i limfocita.
Rezultati: Podaci o primjeni antibiotske terapije odnose se na 266 ispitanika. Većina je ispitanika bila liječena antibioticima (N = 239 (84 %)). Bolesnici na antibiotskoj terapiji imali su više komorbiditeta u odnosu na bolesnike bez antibiotske terapije (P = 0,008). Najčeći komorbiditeti uključivali su bolesti kardiovaskularnog sustava, ali je arterijski tlak bio isti u bolesnika s i bez antibiotske terapije Antibiotik izbora bio je azitromicin u 141 (59 %) bolesnika. Drugi najčešće primijenjeni antibiotik bio je amoksicilin s klavulanskom kiselinom, primijenjen u 117 (49 %) bolesnika. Ceftriakson je primijenjen u 51 bolesnika (21 %), a samo jedan bolesnik liječio se doksiciklinom (0,4 %). Višestruka antibiotska terapija primijenjena je u 41 % bolesnika. Koncentracija ureje, kreatinina, ukupnog bilirubina te D-dimera nije se razlikovala među bolesnicima obzirom na primjenu antibiotske terapije.
Zaključci: Bolesnici na antibiotskoj terapiji češće su imali hipoksemiju i veći broj komorbiditeta. Najčešće su liječeni azitromicinom, a antibiotsko liječenje nije bilo povezano sa smrtnim ishodom. Antibiotsko liječenje COVID-19 bolesnika nije kontraindicirano, ali zahtjeva individualno kliničko prosuđivanje za svakog bolesnika i treba ga provoditi sukladno postojećim smjernicama.
Abstract (english) Introduction: During the COVID-19 pandemic, the frequency of antibiotic use has increased globally. The most serious consequence of the excessive use of antibiotics is the development of multiresistant pathogens, which requires long-term treatment with unpredictable outcomes and causes large costs within the health system.
Objectives: The primary objective of the conducted research was to determine the frequency of use and type of antibiotic therapy for COVID-19 patients hospitalized in KBC Split. The secondary objective was to show the association of the use of antibiotic therapy with comorbidities, selected laboratory findings and death.
Participants and procedures: The retrospective study is part of a larger multicenter study and was conducted on a cohort of 285 patients hospitalized at the Clinic for Infectious Diseases in Split during October and November 2020. For each participant, 244 items from discharge letters were searched, and the analysis included the following variables: age and gender, number of days spent in hospital treatment, data on previous illness, antibiotic therapy used, diagnosed pneumonia, systolic and diastolic blood pressure values, and laboratory findings: value of peripheral blood oxygen saturation, concentration of urea, creatinine, total bilirubin, D dimer and proportion of neutrophils and lymphocytes.
Results: Data on the use of antibiotic therapy refer to 266 subjects. The majority of subjects were treated with antibiotics (N = 239 (84 %)). Patients on antibiotic therapy had more comorbidities compared to patients without antibiotic therapy (P = 0.008). The most common comorbidities included diseases of the cardiovascular system, but arterial pressure was the same in patients with and without antibiotic therapy. The antibiotic of choice was azithromycin in 141 (59%) patients. The second most frequently used antibiotic was amoxicillin with clavulanic acid, used in 117 (49%) patients. Ceftriaxone was used in 51 patients (21%), and only one patient was treated with doxycycline (0.4%). Multiple antibiotic therapy was used in 41% of patients. The concentration of urea, creatinine, total bilirubin and D-dimer did not differ between patients with regard to the use of antibiotic therapy.
Conclusions: Patients on antibiotic therapy more often had hypoxemia and a greater number of comorbidities. Most often, they were treated with azithromycin, and antibiotic treatment was not associated with a fatal outcome. Antibiotic treatment of COVID-19 patients is not contraindicated, but requires individual clinical judgment for each patient and should be carried out in accordance with existing guidelines.
Keywords
COVID-19
SARS-CoV-2
Koronavirus2019
Pandemija
Antibiotici
Antibiotska terapija
Retrospektivno kohortno istraživanje
KBC Split
Keywords (english)
COVID-19
SARS-CoV-2
Coronavirus2019
Pandemic
Antibiotics
Antibiotic therapy
Retrospective cohort study
University Hospital of Split
Language croatian
URN:NBN urn:nbn:hr:171:793100
Study programme Title: Dental Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
Type of resource Text
File origin Born digital
Access conditions Open access Embargo expiration date: 2022-07-26
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Created on 2022-07-21 06:39:46