Initial Empirical Antibiotic Treatment in Patients with COVID-19 is Associated with Excess Adverse Drug Reactions without Clinical Benefit

Objectives: Empirical antibiotic use is common among hospitalized patients with coronavirus disease-2019 (COVID-19) pneumonia because it is difficult to differentiate it from concurrent bacterial pneumonia. The aim of this study was to determine risk factors for concurrent bacterial community-acquired pneumonia (b-CAP) and the need for initial empirical antibiotic coverage in patients with pulmonary involvement caused by Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection.

Materials and methods: This prospective observational study was conducted at a tertiary university hospital between March 2020 and April 2021. Patients aged over 18 years who were hospitalized due to COVID-19 were included. Risk factors and outcomes were compared between patients who initially received empirical antibiotics and those who did not.

Results: The presence of respiratory viral pathogens other than SARS-CoV-2 was investigated via respiratory panel multiplex polymerase chain reaction in 295 patients and potential bacterial respiratory pathogens in 306 patients admitted to the hospital. The co-infection rate was low (17.4%) and 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 older than 65 years (p < 0.001). The overall 30-day mortality rate 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 compared to those who did not.

Conclusion: Initial empirical antibiotic treatment is common among patients infected with SARS-CoV-2, although the coinfection rate is low. Empirical antibiotic(s) did not improve the clinical course in COVID-19 patients.