中重度新冠肺炎住院患者的呼吸道和血液共感染及抗菌药物使用：一项澳大利亚回顾性队列研究
Respiratory and bloodstream coinfections and antimicrobial use in hospitalised patients with moderate to severe COVID-19: An Australian retrospective cohort study.
摘要(中文译文)
COVID-19仍然是全球主要的感染性死亡和住院原因。SARS-CoV-2与其他呼吸道病原体的合并感染可能导致更严重的疾病，然而澳大利亚合并感染的患病率尚不清楚。这项澳大利亚研究旨在确定中重度COVID-19住院患者中呼吸道和血流合并感染的患病率、微生物学特征、抗菌药物使用情况及结局。这是一项回顾性队列研究，纳入2022年2月至7月在阳光海岸大学医院住院的中重度COVID-19成年患者。比较合并感染组与无合并感染组之间在患者特征、合并症、微生物学结果、住院时间、重症监护病房入住及死亡率方面的数据。采用逻辑回归分析识别与合并感染相关的因素。在190例中重度COVID-19住院患者中，23例（12%）记录了合并感染。细菌感染最常见（占合并感染事件的54%），其次为真菌（32%）和病毒（14%）。74%的患者使用了抗生素，中位疗程为6天（IQR 4-8天）。合并感染患者的中位住院时间为9天（IQR：4-19.5），而无合并感染组为6天（IQR：3-9；p = 0.047）。两组之间死亡率无差异。入住重症监护的患者相比未入住重症监护的患者，合并感染的比值比更高（OR 3.39，95% CI 1.19-9.66，p = 0.02）。重症COVID-19和原住民及托雷斯海峡岛民血统也与合并感染相关。这些关系的因果性质需要进一步研究。在我们的COVID-19住院患者队列中，呼吸道和血流合并感染的患病率较低。尽管微生物学检测未标准化，抗生素使用比例却过高。需要进一步开展工作以明确危险因素并改善COVID-19相关合并感染的诊断，从而更好地指导抗菌药物管理。
Abstract
COVID-19 remains a leading infectious cause of death and hospitalisation globally. Coinfections with SARS-CoV-2 and other respiratory pathogens may result in more severe illness, however the prevalence of coinfection in Australia is unknown. This Australian study aimed to determine the prevalence and microbiology of respiratory and bloodstream coinfections, antimicrobial use, and outcomes in hospitalised patients with moderate to severe COVID-19. This was a retrospective cohort study of adult patients with moderate to severe COVID-19, admitted at the Sunshine Coast University Hospital from February to July 2022. Data regarding patient characteristics, comorbidities, microbiological results, hospital length of stay, intensive care unit admission, and mortality were compared between the coinfection and no-coinfection groups. Logistic regression analysis was performed to identify factors associated with coinfection. Coinfection was documented in 23 (12%) of the 190 patients admitted with moderate-severe COVID-19. Bacterial infections were the most common (54% of coinfection episodes), followed by fungal (32%), and viral (14%). Antibiotics were prescribed for 74% of patients, for a median duration of 6 days (IQR 4-8 days). Patients with coinfection had a median length of stay of 9 days (IQR: 4-19.5) compared to 6 days in the no-coinfection group (IQR: 3-9; p = 0.047). There was no mortality difference between the two groups. Patients admitted to intensive care had higher odds of coinfection compared to patients not admitted to intensive care (OR 3.39, 95% CI 1.19-9.66, p = 0.02). Severe COVID-19 and Aboriginal and Torres Strait Islander descent were also associated with coinfection. The causal nature of these relationships requires further interrogation. The prevalence of respiratory and bloodstream coinfection was low in our cohort of hospitalised COVID-19 patients. Despite non-standardised microbiological testing, antibiotic use was disproportionately high. Further work is required to define risk factors and improve diagnosis of COVID-19-associated coinfection, to better inform antimicrobial stewardship.
如何引用
AMA
Laura Frederiksen, Shradha Subedi, Keat Choong, James Anderson, Timothy Baird. Respiratory and bloodstream coinfections and antimicrobial use in hospitalised patients with moderate to severe COVID-19: An Australian retrospective cohort study.. PloS one. 2026; doi:10.1371/journal.pone.0352344.
APA
Laura Frederiksen, Shradha Subedi, Keat Choong, James Anderson, Timothy Baird (2026). Respiratory and bloodstream coinfections and antimicrobial use in hospitalised patients with moderate to severe COVID-19: An Australian retrospective cohort study.. PloS one. https://doi.org/10.1371/journal.pone.0352344
GB/T 7714
Laura Frederiksen, Shradha Subedi, Keat Choong, James Anderson, Timothy Baird. Respiratory and bloodstream coinfections and antimicrobial use in hospitalised patients with moderate to severe COVID-19: An Australian retrospective cohort study.[J]. PloS one, 2026 doi:10.1371/journal.pone.0352344.
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