Initial empirical antibiotic treatment in COVID-19 patients is related with excess adverse drug reactions without clinical benefit

INTRODUCTION: Empirical antibiotic use is common in hospitalized patients with COVID-19 pneumonia because it is difficult to differentiate it from concurrent bacterial pneumonia. In this study, we investigated risk factors for concurrent bacterial community-acquired pneumonia (b-CAP) and the need for initial empirical antibiotic coverage when patients presented with pulmonary involvement caused by SARS CoV-2.
METHODS: This study was conducted as a prospective and observational study in a tertiary university hospital between March 2020 and April 2021. Patients over 18 years of age who were hospitalized with COVID-19 pneumonia were included. Risk factors and outcomes were compared between the patients who received initial empirical antibiotics and those who did not.
RESULTS: The presence of respiratory viral pathogens other than SARS CoV-2 was investigated via a respiratory panel multiplex polymerase chain reaction in 295 patients, and potential bacterial respiratory pathogens in 306 patients on admission to the hospital. Although the co-infection rate was low (17.4%), half of the patients (205/409, 50.1%) were administered initial empirical antibiotics for suspected concurrent b-CAP. Antibiotic use was higher in patients with multiple comorbidities, severe to critical pneumonia, and patients over 65 years (p<0.001). The overall 30-day mortality was significantly higher (26.3% and 2.0%, p<0.001), and the duration of hospital stay was longer (median 13.0 and 5.5 days, p<0.001) in patients who received empirical antibacterial agents.
DISCUSSION AND CONCLUSION: Initial empirical antibiotic treatment is common in patients infected with SARS CoV-2, although the co-infection rate is low. Empirical antibiotic(s) did not improve the clinical course in COVID-19 patients.