Early Antiviral Use and Supplemental Oxygen Decrease the Risk of Secondary Bacterial Infections: A Multicentre Nested Case-Control Study

Yixing Zhu; Haiming Hu; Xin Guo; Hong Zhang; Dandan Li; Charles S Dela Cruz; Wuxiang Xie; Lixin Xie; Lokesh Sharma; De Chang

doi:10.1016/j.jhin.2024.12.005

Early Antiviral Use and Supplemental Oxygen Decrease the Risk of Secondary Bacterial Infections: A Multicentre Nested Case-Control Study

J Hosp Infect. 2024 Dec 17:S0195-6701(24)00407-9. doi: 10.1016/j.jhin.2024.12.005. Online ahead of print.

Authors

Yixing Zhu¹, Haiming Hu¹, Xin Guo², Hong Zhang³, Dandan Li³, Charles S Dela Cruz⁴, Wuxiang Xie⁵, Lixin Xie⁶, Lokesh Sharma⁷, De Chang⁸

Affiliations

¹ Department of Pulmonary and Critical Care Medicine at The Seventh Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Department of Pulmonary and Critical Care Medicine at The First Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
² Department of Pulmonary and Critical Care Medicine at The Third Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
³ Department of Pulmonary and Critical Care Medicine at The Seventh Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
⁴ Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA 15213, USA.
⁵ Peking University Clinical Research Institute, Beijing, 100191, China.
⁶ Department of Pulmonary and Critical Care Medicine at The Seventh Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Department of Pulmonary and Critical Care Medicine at The First Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Department of Pulmonary and Critical Care Medicine at The Third Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; State Key Laboratory of Kidney Disease, Beijing, 100853, China. Electronic address: 2464277169@qq.com.
⁷ Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA 15213, USA. Electronic address: Sharmalk2@upmc.edu.
⁸ Department of Pulmonary and Critical Care Medicine at The Seventh Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Department of Pulmonary and Critical Care Medicine at The First Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; Department of Pulmonary and Critical Care Medicine at The Third Medical Center, College of Pulmonary and Critical Care Medicine of The Eighth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China; State Key Laboratory of Kidney Disease, Beijing, 100853, China. Electronic address: changde@301hospital.com.cn.

PMID: 39701496
DOI: 10.1016/j.jhin.2024.12.005

Abstract

Objective: To evaluate the treatment strategies that dictate the host susceptibility to secondary bacterial infections during coronavirus disease 2019 (COVID-19).

Design: Setting and Participants: This nested case-control study was conducted in three general hospitals in China between December 1, 2022, to March 1, 2023. A total of 456 confirmed COVID-19 patients matched 1:2 (152 cases and 304 controls) based on age, sex, disease severity and age-adjusted Charlson Comorbidity Index (aCCI) using Propensity-Score Matching (PSM) were included.

Main outcome measures: Association of secondary bacterial infections with treatment strategies including the supportive measures, antiviral, and antibacterial therapies.

Results: Conditional logistic regression analyses demonstrated that among categorical variables, use of antibiotics, antivirals, intravenous injection of human immunoglobulin, glucocorticoids or anticoagulants were not associated with the risk of secondary bacterial infections in the COVID-19 patients. The use of supplemental oxygen by either low (Odds ratio (OR): 0.18, P<0.001) or high flow (OR: 0.06, P<0.001), but not through ventilators were associated with significant protection against secondary bacterial infection. In contrast, feeding through gastric tube (OR: 10.97, P<0.001) or parenteral nutrition (OR: 3.97, P = 0.002) was associated with significant increase in the risk of secondary bacterial infections. Similar data were obtained when data were analysed using continuous variables. Further, the early (<5 days post symptom onset, OR: 0.09, P<0.001)), but not the late use of antivirals were associated with the protection against secondary bacterial infections.

Conclusions: Oxygen supplementation in a non-ventilator settings and early use of antivirals were associated with decreased incidences of secondary bacterial infections, while parenteral nutrition or tube feedings were associated with increased incidences of secondary bacterial infections.

Keywords: Antibiotics; Antivirals; Coronavirus disease 2019; Pneumonia.