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Antibiotic Prescription and In-Hospital Mortality in COVID-19: A Prospective Multicentre Cohort Study
Larisa Pinte1,2,3, Alexandr Ceasovschih4,5, Cristian-Mihail Niculae1,6
1Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Insights
Antibiotic use in COVID-19 patients did not reduce mortality. In fact, antibiotics were linked to increased deaths, especially in patients without a clear need for them, highlighting judicious antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Empiric antibiotic (ATB) use increased during the COVID-19 pandemic for hospitalized patients.
- Assessing the impact of ATB treatment on COVID-19 patient outcomes is crucial.
Purpose of the Study:
- To evaluate the association between antibiotic treatment and mortality in hospitalized patients with moderate to severe COVID-19.
- To investigate if antibiotic use impacts outcomes differently based on the indication for treatment.
Main Methods:
- Prospective, multicenter cohort study involving six hospitals.
- Data collected from January 2021 to May 2021, including 553 hospitalized COVID-19 patients.
- Analysis of mortality rates and association with antibiotic use, adjusting for confounders.
Main Results:
- 58% of patients received antibiotics; bacteriological tests were performed in 57% of those.
- Antibiotic use was associated with higher mortality (RR = 3.37).
- This association was significantly stronger in patients without clear indications for antibiotics (RR = 6.1, adjusted OR = 10.3).
Conclusions:
- Antibiotic treatment did not decrease mortality in COVID-19 patients.
- Antibiotic use was associated with increased mortality, particularly in patients without a documented need for antimicrobial therapy.
- Findings underscore the importance of antibiotic stewardship in COVID-19 management.
Background:
Since the beginning of the COVID-19 pandemic, empiric antibiotics (ATBs) have been prescribed on a large scale in both in- and outpatients. We aimed to assess the impact of antibiotic treatment on the outcomes of hospitalised patients with moderate and severe coronavirus disease 2019 (COVID-19).
Methods:
We conducted a prospective multicentre cohort study in six clinical hospitals, between January 2021 and May 2021.
Results:
We included 553 hospitalised COVID-19 patients, of whom 58% (311/553) were prescribed antibiotics, while bacteriological tests were performed in 57% (178/311) of them. Death was the outcome in 48 patients-39 from the ATBs group and 9 from the non-ATBs group. The patients who received antibiotics during hospitalisation had a higher mortality (RR = 3.37, CI 95%: 1.7-6.8), and this association was stronger in the subgroup of patients without reasons for antimicrobial treatment (RR = 6.1, CI 95%: 1.9-19.1), while in the subgroup with reasons for antimicrobial therapy the association was not statistically significant (OR = 2.33, CI 95%: 0.76-7.17). After adjusting for the confounders, receiving antibiotics remained associated with a higher mortality only in the subgroup of patients without criteria for antibiotic prescription (OR = 10.3, CI 95%: 2-52).
Conclusions:
In our study, antibiotic treatment did not decrease the risk of death in the patients with mild and severe COVID-19, but was associated with a higher risk of death in the subgroup of patients without reasons for it.
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