Is there a need to widely prescribe antibiotics in patients hospitalized with COVID-19?

Abstract

Background: Debate continues regarding the usefulness and benefits of wide prescription of antibiotics in patients hospitalized with coronavirus disease 2019 (COVID-19).

Methods: All patients hospitalized in the Infectious Diseases Department, Dijon University Hospital, Dijon, France between 27 February and 30 April 2020 with confirmed COVID-19 were included in this study. Clinical, biological and radiological data were collected, as well as treatment and outcome data. An unfavourable outcome was defined as death or transfer to the intensive care unit. Patient characteristics and outcomes were compared between patients who did and did not receive antibiotic therapy using propensity score matching.

Findings: Among the 222 patients included, 174 (78%) received antibiotic therapy. The univariate analysis showed that patients who received antibiotic therapy were significantly older, frailer and had more severe presentation at admission compared with patients who did not receive antibiotic therapy. Unfavourable outcomes were more common in patients who received antibiotic therapy [hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.07-8.11; P = 0.04]. Multi-variate analysis and propensity score matching indicated that antibiotic therapy was not significantly associated with outcome (HR 1.612, 95% CI 0.562-4.629; P = 0.37).

Conclusion: Antibiotics were frequently prescribed in this study and this was associated with more severe presentation at admission. However, antibiotic therapy was not associated with outcome, even after adjustment. In line with recent publications, such data support the need to streamline antibiotic therapy in patients with COVID-19.

Keywords: Antibiotic therapy; COVID-19; Prognosis; SARS-CoV-2.

Figure 1

Factors associated with death or transfer to intensive care unit in 28 days following admission in patients hospitalized with coronavirus disease 2019 (COVID-19) who did and did not receive antibiotic therapy according to multi-variate regression analysis (Cox method). Propension matching score was adjusted for: sex, age (< or ≥75 years), diabetes mellitus, cardiovascular disease, respiratory disease, obesity, immunosuppression, cirrhosis, chronic kidney disease, place of residence (home or other), depression, fever, dyspnoea, flu syndrome, confusion, anosmia, prescription of specific COVID-19 treatment, prescription of corticosteroid, degree of lesions on computed tomography (CT) scan lesions (reference: no lesions²), National Early Warning Score 2 (NEWS2) class on Day 0 (D0) (reference: Class 1¹), Quick Sepsis-related Organ Failure Assessment (qSOFA) score at D0, and CRB65 (confusion, respiratory rate, blood pressure, 65 years old) score at D0. HR, hazard ratio; CI, confidence interval.