Terapia de antibióticos en hospitalizados por COVID-19: Revisión sistemática con meta-análisis.
DOI:
https://doi.org/10.35434/rcmhnaaa.2022.15Supl.%201.1651Palabras clave:
Antibiótico, Terapia empírica, Hospitalización, COVID-19Resumen
Introducción: El objetivo del estudio está basado en determinar si el uso de antibiótico terapia empírica aumenta el riesgo de muerte en los pacientes adultos mayores de 18 años hospitalizados con COVID-19. Métodos: Se realizó una revisión sistemática y meta-análisis, para lo cual se tomó en cuenta estudios retrospectivos y prospectivos. Para la búsqueda sistemática se usaron las bases de datos electrónicas Medline/PubMed, Embase, LILACS y CINAHL en el periodo de diciembre 2019 a mayo del 2021. Se calcularon los Odds Ratio y los intervalos de confianza al 95% utilizando el efecto aleatorio, en función de que exista o no heterogeneidad, se elaboró el gráfico de Funnel Plot para evaluar el riesgo de sesgo. Resultados: Se localizaron 528 artículos, que cumplieron con los criterios de inclusión y exclusión, se evaluó la elegibilidad de los textos completos de 90 estudios, de los cuales se tuvo como resultado 10 artículos. El Odds Ratio de los 10 estudios es de 1,55(1,20-2,01), a favor del no uso de antibióticos, con un I2 de heterogeneidad entre los estudios del 50%, y la antibiótico terapia empírica guiada con procalcitonina < 0,5 ng/dl el Odds Ratio fue de 28,99 (10,17-82,64) con un I2 de heterogeneidad del 0%. Conclusión: Los resultados nos indican que al administrar el antibiótico sin evidencia de datos microbiológicos aumenta la mortalidad en dichos pacientes y al contrario el no usar antibiótico terapia empírica reduce la mortalidad en los pacientes infectados con COVID-19 graves que llegaron a los hospitales.
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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.
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Derechos de autor 2022 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
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
