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

Davido, Benjamin; Boussaid, Ghilas; Vaugier, Isabelle; Lansaman, Thibaud; Bouchand, Frédérique; Lawrence, Christine; Alvarez, Jean-Claude; Moine, Pierre; Perronne, Véronique; Barbot, Frédéric; Saleh-Mghir, Azzam; Perronne, Christian; Annane, Djillali; De Truchis, Pierre

INTRODUCTION: Interest of anti-infective agents in COVD-19 showed discrepant results. However, there is no evaluation about the impact in changes of practices on the prognosis over time. METHODS: Single center, retrospective study, conducted from March 5(th) to April 25(th) 2020, in adults hospitalized in a medicine ward for a COVID-19. Patient characteristics were compared between 2 periods (before/after March 19(th)) considering French guidelines issued by learned societies. Aim of the study was to evaluate how medical care impacted unfavorable outcome, namely admission in intensive care unit (ICU) and/or death. RESULTS: One hundred thirty-two patients were admitted, mean age was 59.0 ± 16.3 years, mean CRP level was 84.0±71.1 mg/L, 46% had a lymphocyte count<1000/mm(3). When prescribed, anti-infective agents were lopinavir-ritonavir (n=12), azithromycin (AZI) (n=28) and AZI combined with hydroxychloroquine (HCQ) (n=52). Between the 2 periods we noted a significant decrease of ICU admission, from 43% to 12% (p<0.0001). Delays until transfer in ICU were similar between periods (p=0.86). Pulmonary CT-scan were significantly more performed (from 50% to 90%, p<0.0001), as oxygen-dependency (53% vs 80%, p=0.001) and prescription of AZI±HCQ (from 25% to 76%, p<0.0001) were greater over time. Multivariate analyses showed a reduction of unfavorable outcome in patients receiving AZI±HCQ (HR=0.45, 95%IC [0.21-0.97], p=0.04), especially among an identified category of individuals (lymphocyte≥1000/mm(3) or CRP≥100 mg/L). CONCLUSION: The present study revealed a significant decrease of admission in ICU over time probably related to multiple factors, including a better indication of pulmonary CT-scan, of oxygen therapy, and a suitable prescription of anti-infective agents.