Current Guidelines May Lead to Antibiotic Overuse for SARS-CoV-2 Pneumonia
Bacterial superinfection at time of intubation occurred in <25 percent of patients; reduced antibiotic use seen with bronchoalveolar lavage-based management versus current guidelines
FRIDAY, Sept. 3, 2021 (HealthDay News) -- Current guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia would result in overuse of antibiotics at the time of intubation, according to a study published online Aug. 17 in the American Journal of Respiratory and Critical Care Medicine.
Chiagozie O. Pickens, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined the prevalence and etiology of bacterial superinfection at the time of initial intubation and the incidence and etiology of subsequent bacterial ventilator-associated pneumonia (VAP) in patients with severe SARS-CoV-2 pneumonia. Bronchoscopic bronchoalveolar lavage (BAL) fluid samples were analyzed from all patients with SARS-CoV-2 pneumonia requiring mechanical ventilation. Antibody use was compared to guideline-recommended therapy. Three hundred eighty-six BAL samples from 179 patients were analyzed.
The researchers found that 21 percent of the patients had bacterial superinfection within 48 hours of intubation. Of the patients, 44.4 percent developed at least one VAP episode (incidence rate, 45.2/1,000 ventilator days); difficult-to-treat pathogens caused 20.8 percent of initial VAPs. Clinical criteria could not differentiate between patients with or without bacterial superinfection. Significantly reduced antibiotic use was seen in association with BAL-based management compared with guideline recommendations.
"An accurate diagnosis of suspected pneumonia allows clinicians to safely avoid or use narrow spectrum antibiotics for many patients," a coauthor said in a statement. "While multiple interventions impact mortality in these critically ill patients, the low mortality in our study with more limited antibiotic treatment suggests that our approach was safe."