Terapia de antibióticos en hospitalizados por COVID-19: Revisión sistemática con meta-análisis.

Luis A.  Coaguila Cusicanqui; Darwin A.  León-Figueroa; Yuriko L.  Cavero Reyes; Ariana L.  Montenegro Sialer; Danitza I.  Pisfil Nanfuñay; Lilia Jannet  Saldarriaga Sandoval; Joshuan J. Barboza; Alfonso J.  Rodriguez-Morales

doi:10.35434/rcmhnaaa.2022.15Supl. 1.1651

Authors

Luis A. Coaguila Cusicanqui Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Perú.
Darwin A. León-Figueroa Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Perú.
Yuriko L. Cavero Reyes Escuela de Post Grado, Universidad San Martín de Porres, Lima, Peru.
Ariana L. Montenegro Sialer Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Perú.
Danitza I. Pisfil Nanfuñay Facultad de Medicina Humana, Universidad Señor de Sipán, Chiclayo, Peru.
Lilia Jannet Saldarriaga Sandoval Universidad Nacional de Tumbes, Tumbes, Perú
Joshuan J. Barboza Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Peru.
Alfonso J. Rodriguez-Morales Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia; Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru; School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia

DOI:

https://doi.org/10.35434/rcmhnaaa.2022.15Supl.%201.1651

Keywords:

Antibiotic, Empiric therapy, Hospitalization, COVID-19

Abstract

Introduction: The aim of the study is based on determine whether the use of empirical antibiotic therapy increases the risk of death in adult patients older than 18 years hospitalized with COVID-19. Material and Methods: A systematic review and meta-analysis were performed, taking into account retrospective and prospective studies. The electronic databases Medline/PubMed, Embase, LILACS, and CINAHL were used for the systematic search in the period from December 2019 to May 2021. Odds Ratio and 95% confidence intervals were calculated using the random effect, depending on whether or not heterogeneity exists, the Funnel Plot graph was elaborated to assess the risk of bias. Results: 528 articles were located, which met the inclusion and exclusion criteria, and the eligibility of the full texts of 90 studies was evaluated, resulting in 10 articles. The Odds Ratio of the 10 studies is 1.55 (1.20-2.01), in favor of the non-use of antibiotics, with an I2 of heterogeneity between studies of 50%, and the empirical antibiotic therapy guided with procalcitonin < 0.5 ng/dl the Odds Ratio was 28.99 (10.17-82.64) with an I2 of heterogeneity of 0%. Conclusion: The results indicate that administering antibiotics without evidence of microbiological data increases mortality in these patients and, on the contrary, not using empirical antibiotic therapy reduces mortality in patients infected with severe COVID-19 who arrived at the hospital.

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Author Biographies

Darwin A. León-Figueroa , Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Perú.

1. Estudiante de Medicina Humana

Ariana L. Montenegro Sialer , Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Perú.

1. Estudiante de Medicina Humana

Danitza I. Pisfil Nanfuñay , Facultad de Medicina Humana, Universidad Señor de Sipán, Chiclayo, Peru.

1. Estudiante de Medicina Humana

Joshuan J. Barboza, Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Peru.

1. Maestría en Investigación Epidemiológica

References

Poudel S, Ishak A, Perez-Fernandez J, Garcia E, León-Figueroa DA, Romaní L, et al. Highly mutated SARS-CoV-2 Omicron variant sparks significant concern among global experts – What is known so far? Travel Med Infect Dis 2022;45:102234. https://doi.org/10.1016/J.TMAID.2021.102234.

Tsang HF, Chan LWC, Cho WCS, Yu ACS, Yim AKY, Chan AKC, et al. An update on COVID-19 pandemic: the epidemiology, pathogenesis, prevention and treatment strategies. Expert Rev Anti Infect Ther 2021;19:877–88. https://doi.org/10.1080/14787210.2021.1863146.

Rodriguez-Morales AJ, León-Figueroa DA, Romaní L, McHugh TD, Leblebicioglu H. Vaccination of children against COVID-19: the experience in Latin America. Ann Clin Microbiol Antimicrob 2022;21:1–5. https://doi.org/10.1186/S12941-022-00505-7/FIGURES/1.

WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data n.d. https://covid19.who.int/ (accessed July 14, 2022).

Rahman S, Montero MTV, Rowe K, Kirton R, Kunik F. Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence. Expert Rev Clin Pharmacol 2021;14:601–21. https://doi.org/10.1080/17512433.2021.1902303.

Khan M, Adil SF, Alkhathlan HZ, Tahir MN, Saif S, Khan M, et al. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules 2020;26. https://doi.org/10.3390/MOLECULES26010039.

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses 2020;12. https://doi.org/10.3390/V12040372.

Atzrodt CL, Maknojia I, McCarthy RDP, Oldfield TM, Po J, Ta KTL, et al. A Guide to COVID-19: a global pandemic caused by the novel coronavirus SARS-CoV-2. FEBS J 2020;287:3633–50. https://doi.org/10.1111/FEBS.15375.

Párraga Martínez I, Pérula de Torres LA, González Lama J, Jiménez García C, Sánchez Montero R, Rider Garrido F. [Clinical and epidemiological characteristics of SARS-CoV-2 infections in family physicians: A case-control study]. Aten Primaria 2021;53. https://doi.org/10.1016/J.APRIM.2020.12.001.

Ramón M, Abreu P, Jesús Gómez Tejeda J, Alejandro R, Guach D. Clinical-epidemiological characteristics of COVID-19. Revista Habanera de Ciencias Médicas 2020:1–15.

Sreepadmanabh M, Sahu AK, Chande A. COVID-19: Advances in diagnostic tools, treatment strategies, and vaccine development. J Biosci 2020;45. https://doi.org/10.1007/S12038-020-00114-6.

Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, Oyewunmi OD, Camargo C, Nikpour B, et al. Tools and Techniques for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/COVID-19 Detection. Clin Microbiol Rev 2021;34. https://doi.org/10.1128/CMR.00228-20.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62. https://doi.org/10.1016/S0140-6736(20)30566-3.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475–81. https://doi.org/10.1016/S2213-2600(20)30079-5.

Rosca A, Balcaen T, Michaud A, Lanoix JP, Moyet J, Marcq I, et al. Mortality risk and antibiotic use for COVID-19 in hospitalized patients over 80. Biomedicine & Pharmacotherapy 2022;146:112481. https://doi.org/10.1016/J.BIOPHA.2021.112481.

Pettit NN, Nguyen CT, Lew AK, Bhagat PH, Nelson A, Olson G, et al. Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission. BMC Infect Dis 2021;21:1–7. https://doi.org/10.1186/S12879-021-06219-Z/TABLES/2.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372. https://doi.org/10.1136/BMJ.N71.

Hu H, Ji Z, Feng C, Pang W, Chen Z, Zhang J, et al. PROSPERO’s systematic review protocols of traditional Chinese medicine for COVID-19: An overview. Integr Med Res 2021;10. https://doi.org/10.1016/J.IMR.2021.100774.

Cañón M, Buitrago-Gómez Q. The Research Question in Clinical Practice: A Guideline for Its Formulation. Revista Colombiana de Psiquiatria (English Ed) 2018;47:193–200. https://doi.org/10.1016/J.RCP.2016.06.004.

Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cir Esp 2014;92:82–8. https://doi.org/10.1016/J.CIRESP.2013.08.002.

Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46:846–8. https://doi.org/10.1007/S00134-020-05991-X.

Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368. https://doi.org/10.1136/BMJ.M1091.

Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chin Med J (Engl) 2020;133:1261–7. https://doi.org/10.1097/CM9.0000000000000824.

Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Bordell A, et al. Características, evolución clínica y factores asociados a la mortalidad en UCI de los pacientes críticos infectados por SARS-CoV-2 en España: estudio prospectivo, de cohorte y multicéntrico. Rev Esp Anestesiol Reanim 2020;67:425. https://doi.org/10.1016/J.REDAR.2020.07.003.

Morrison AR, Johnson JM, Griebe KM, Jones MC, Stine JJ, Hencken LN, et al. Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab. J Autoimmun 2020;114. https://doi.org/10.1016/J.JAUT.2020.102512.

Okoh AK, Sossou C, Dangayach NS, Meledathu S, Phillips O, Raczek C, et al. Coronavirus disease 19 in minority populations of Newark, New Jersey. Int J Equity Health 2020;19:1–8. https://doi.org/10.1186/S12939-020-01208-1/TABLES/2.

Wang D, Yin Y, Hu C, Liu X, Zhang X, Zhou S, et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care 2020;24. https://doi.org/10.1186/S13054-020-02895-6.

Zerah L, Baudouin É, Pépin M, Mary M, Krypciak S, Bianco C, et al. Clinical Characteristics and Outcomes of 821 Older Patients With SARS-Cov-2 Infection Admitted to Acute Care Geriatric Wards. J Gerontol A Biol Sci Med Sci 2021;76:E4–12. https://doi.org/10.1093/GERONA/GLAA210.

Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis 2020;71:2459–68. https://doi.org/10.1093/CID/CIAA530.

Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020;46:854–87. https://doi.org/10.1007/S00134-020-06022-5.

Liu C, Wen Y, Wan W, Lei J, Jiang X. Clinical characteristics and antibiotics treatment in suspected bacterial infection patients with COVID-19. Int Immunopharmacol 2021;90. https://doi.org/10.1016/J.INTIMP.2020.107157.

Chedid M, Waked R, Haddad E, Chetata N, Saliba G, Choucair J. Antibiotics in treatment of COVID-19 complications: a review of frequency, indications, and efficacy. J Infect Public Health 2021;14:570–6. https://doi.org/10.1016/J.JIPH.2021.02.001.

Langford BJ, So M, Raybardhan S, Leung V, Soucy JPR, Westwood D, et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021;27:520–31. https://doi.org/10.1016/J.CMI.2020.12.018.

Pink I, Raupach D, Fuge J, Vonberg RP, Hoeper MM, Welte T, et al. C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19. Infection 2021;49:935–43. https://doi.org/10.1007/S15010-021-01615-8/FIGURES/2.

Pérez-Lazo G, Soto-Febres F, Morales-Moreno A, Cabrera-Enríquez JA, Díaz-Agudo J, Rojas-Tovar R, et al. Uso racional de antimicrobianos en tiempos de COVID-19 en Perú: rol de los programas de optimización del uso de antimicrobianos e intervenciones desde el punto de vista de control de infecciones. Horizonte Médico (Lima) 2021;21:e1254. https://doi.org/10.24265/HORIZMED.2021.V21N2.12.

Martin AJ, Shulder S, Dobrzynski D, Quartuccio K, Pillinger KE. Antibiotic Use and Associated Risk Factors for Antibiotic Prescribing in COVID-19 Hospitalized Patients. J Pharm Pract 2021. https://doi.org/10.1177/08971900211030248.

Beovic B, Dousak M, Ferreira-Coimbra J, Nadrah K, Rubulotta F, Belliato M, et al. Antibiotic use in patients with COVID-19: a “snapshot” Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrob Chemother 2020;75:3386–90. https://doi.org/10.1093/JAC/DKAA326.

Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020;81:e16–25. https://doi.org/10.1016/J.JINF.2020.04.021.

Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis 2020;14. https://doi.org/10.1177/1753466620937175.