COVID-19 Tanısıyla Yatan Hastalarda Antibiyotik Kullanımının Yoğun Bakım Ünitesine Yatış ve Mortalite Üzerine Etkisi

Year 2025, Issue: Early Access

Taliha Karakök , Ahmet Doğan , Onur Acar

https://doi.org/10.18678/dtfd.1513307

Abstract

Amaç: Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) pandemisinin antibiyotik yönetimi üzerinde doğrudan bir etkisi olmuştur ve olmaya devam etmektedir. Bu çalışmanın amacı, COVID-19 hastalarında antibiyotik kullanımı ve bunun yoğun bakım ünitesine (YBÜ) yatış ve mortalite üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: Enfeksiyonun klinik bulguları olan ve serviste takip edilen ≥18 yaş 324 COVID-19 hastasının tıbbi kayıtları geriye dönük olarak değerlendirildi. Hastalar antibiyotik tedavisi alanlar ve almayan olmak üzere iki ayrı gruba ayrıldı. YBÜ'den servise devredilen, birinci gün taburcu edilen veya eksik verisi olan hastalar çalışma dışı bırakıldı.
Bulgular: Hastaların 172’si (%53,1) erkek, 152’si (%46,9) kadın ve 212’si (%65,4) antibiyotik tedavisi almıştı. Bir haftadan uzun hastanede yatış (p<0,001), pulse steroid kullanımı (p=0,011), yoğun bakım yatışı (p=0,002) ve mortalite (p<0,001) antibiyotik kullanan hastalarda anlamlı olarak daha yüksekti. Antibiyotik kullanan hastalarda yatışta ve 48-72. saatlerde elde edilen CRP (p<0,001), PCT (p=0,001) ve ferritin (p=0,017) değerleri de daha yüksek bulunurken, taburculuktaki CRP değeri (p=0,052) açısından fark yoktu. Hastanede yatış süresi, antibiyotik kullanımı, pulse steroid kullanımı ve 60 yaş ve üzeri olmak mortalite ve YBÜ yatış için risk faktörleri olarak bulunmuştur.
Sonuç: COVID-19 hastalarında aşırı antibiyotik kullanımının, mortalite ve YBÜ gereksinimi üzerinde olumlu bir etkisi olmamıştır. Aşırı antibiyotik kullanımının zararları göz önüne alınarak akılcı antibiyotik kullanımına yönlendiren öneri ve uygulamalara ihtiyaç vardır. Bununla birlikte mortalite ve YBÜ yatışı yordayan faktörlerin klinik pratikte kullanımı fayda sağlayabilir.

Keywords

antibiyotik, COVID-19, yoğun bakım ünitesi, mortalite

The Effect of Antibiotic Use on Intensive Care Unit Admission and Mortality in Inpatients with COVID-19 Diagnosis

Abstract

Aim: The coronavirus disease 2019 (COVID-19) pandemic had and continues to directly impact antibiotic management. This study aimed to evaluate antibiotic use and its impact on intensive care unit (ICU) admission and mortality in COVID-19 patients.
Material and Methods: The medical records of 324 COVID-19 patients aged ≥18 years who had clinical signs of infection and were followed up in the service were retrospectively evaluated. Patients were divided into two groups, those who received antibiotics and those who did not. Patients transferred from the ICU to the ward, discharged on the first day, or had missing data were excluded from the study.
Results: Of the patients, 172 (53.1%) were male, 152 (46.9%) were female, and 212 (65.4%) received antibiotic treatment. Hospitalization longer than one week (p<0.001), pulse steroid use (p=0.011), ICU admission (p=0.002) and mortality (p<0.001) were significantly higher in patients receiving antibiotics. While CRP (p<0.001), PCT (p=0.001), and ferritin (p=0.017) values obtained at admission and 48-72 hours were also found to be higher in antibiotic-using patients, there was no difference in CRP value (p=0.052) at discharge. Duration of hospitalization, antibiotic use, pulse steroid use, and being 60 years and older were found to be risk factors for mortality and ICU admission.
Conclusion: Overusing antibiotics in COVID-19 patients did not have a positive effect on mortality and ICU requirements. Considering the harms of excessive antibiotic use, recommendations and practices that lead to rational antibiotic use are needed. Furthermore, factors predicting mortality and ICU can be used in clinical practice.

Keywords

antibiotic, COVID-19, intensive care unit, mortality

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