Comparative Safety of Empirical Antibiotic Classes in Newly Hospitalized COVID-19 Patients

Area of Science:

• Infectious Diseases
• Pharmacology
• Critical Care Medicine

Background:

• Empirical antibiotic use is prevalent in COVID-19 patients, despite low bacterial coinfection rates.
• Concerns exist regarding antimicrobial resistance and inappropriate antibiotic prescribing.
• Comparative safety data for antibiotic classes in COVID-19 patients are limited.

Purpose of the Study:

• To compare the safety and outcomes of different empirical antibiotic classes used in hospitalized COVID-19 patients.
• To investigate associations between antibiotic choice and critical care interventions or mortality.

Main Methods:

• Retrospective cohort study utilizing real-world clinical data (Observational Medical Outcomes Partnership Common Data Model).
• Inclusion of adult COVID-19 patients receiving empirical antibiotics on admission.
• Categorization of antibiotic exposure: third-generation cephalosporins (3GCs), fluoroquinolones, and aminopenicillins with β-lactamase inhibitors (PEN-BLis).

Main Results:

• Fluoroquinolone use showed significantly higher risks of mechanical ventilation, ICU admission, vasopressor use, and all-cause in-hospital mortality compared to 3GCs.
• Aminopenicillins with β-lactamase inhibitors (PEN-BLis) did not demonstrate significant outcome differences compared to 3GCs.
• Hazard ratios for fluoroquinolones ranged from 1.32 to 1.55 across various critical outcomes.

Conclusions:

• Empirical fluoroquinolone use in COVID-19 patients may increase risks for critical care interventions and mortality.
• Third-generation cephalosporins appear to be a safer empirical choice compared to fluoroquinolones.
• Clinical judgment and careful patient selection are essential when prescribing empirical antibiotics for viral respiratory infections like COVID-19.