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. 2020 Oct;56(4):106129.
doi: 10.1016/j.ijantimicag.2020.106129. Epub 2020 Aug 2.

Impact of medical care, including use of anti-infective agents, on prognosis of COVID-19 hospitalized patients over time

Benjamin Davido  1 , Ghilas Boussaid  2 , Isabelle Vaugier  3 , Thibaud Lansaman  4 , Frédérique Bouchand  5 , Christine Lawrence  6 , Jean-Claude Alvarez  7 , Pierre Moine  8 , Véronique Perronne  9 , Frédéric Barbot  3 , Azzam Saleh-Mghir  9 , Christian Perronne  9 , Djillali Annane  8 , Pierre De Truchis  9 ; COVID-19 RPC Team
Affiliations

Impact of medical care, including use of anti-infective agents, on prognosis of COVID-19 hospitalized patients over time

Benjamin Davido et al. Int J Antimicrob Agents. 2020 Oct.

Abstract

Introduction: The effect of anti-infective agents in COVID-19 is unclear. The impact of changes in practice on prognosis over time has not been evaluated.

Methods: Single center, retrospective study in adults hospitalized in a medicine ward for COVID-19 from March 5th to April 25th 2020. Patient characteristics were compared between two periods (before/after March 19th) considering French guidelines. The aim of the study was to evaluate how medical care impacted unfavorable outcome, namely admission to intensive care unit (ICU) and/or death.

Results: A total of 132 patients were admitted: mean age 59.0±16.3 years; mean C-reactive protein (CRP) level 84.0±71.1 mg/L; 46% had a lymphocyte count <1000/mm3. Prescribed anti-infective agents were lopinavir-ritonavir (n=12), azithromycin (AZI) (n=28) and AZI combined with hydroxychloroquine (HCQ) (n=52). There was a significant decrease in ICU admission, from 43% to 12%, between the two periods (P<0.0001). Delays until transfer to ICU were similar between periods (P=0.86). Pulmonary computerized tomography (CT)-scans were performed significantly more often with time (from 50% to 90%, P<0.0001), and oxygen-dependency (53% vs 80%, P=0.001) and prescription of AZI±HCQ (from 25% to 76%, P<0.0001) were also greater over time. Multivariate analyses showed a reduction of unfavorable outcome in patients receiving AZI±HCQ (hazard ratio [HR]=0.45, 95% confidence interval [CI: 0.21-0.97], P=0.04), particularly among an identified category of individuals (lymphocyte ≥1000/mm3 or CRP ≥100 mg/L).

Conclusion: The present study showed a significant decrease in admission to ICU over time, which was probably related to multiple factors, including a better indication of pulmonary CT-scan, oxygen therapy, and a suitable prescription of anti-infective agents.

Keywords: Covid-19; azithromycin; hydroxychloroquine; pneumonia.

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Figures

Figure 1
Fig. 1
Evolution of medical care for COVID-19 patients from March 5th to April 25th.
Figure 2
Fig. 2
a Kaplan-Meier survival curve for patients with an unfavorable outcome in function of treatment according to lymphocyte count ≥1000/mm3 (Log-Rank, P = 0.04). b Kaplan-Meier survival curve for patients with an unfavorable outcome in function of treatment according to CRP ≥100 mg/L (Log-Rank, P = 0.009).
See this image and copyright information in PMC

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