Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics

A Kopp-Derouet; S Diamantis; S Chevret; A Tazi; R Burlacu; J P Kevorkian; J B Julla; J M Molina; P Sellier

doi:10.1093/jac/dkae350

Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics

J Antimicrob Chemother. 2024 Sep 27:dkae350. doi: 10.1093/jac/dkae350. Online ahead of print.

Authors

A Kopp-Derouet^{1

2

3

4}, S Diamantis^{3

4}, S Chevret^{5

2}, A Tazi^{6

2}, R Burlacu^{7

2}, J P Kevorkian^{8

2}, J B Julla^{8

2}, J M Molina^{1

2}, P Sellier^{1

2}

Affiliations

¹ Infectious Diseases Department, Hôpitaux Saint-Louis/Lariboisière, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France.
² Université de Paris Cité, Paris, France.
³ Infectious Diseases and Internal Medicine Department, GH SIF, Melun, France.
⁴ DYNAMIC Unit, UPEC, Créteil, France.
⁵ Department of Biostatistics and Medical Informatics, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France.
⁶ Department of Respiratory Diseases, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France.
⁷ Department of Internal Medicine, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France.
⁸ Department of Endocrinology, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France.

PMID: 39327031
DOI: 10.1093/jac/dkae350

Abstract

Background: During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical.

Methods: We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations.

Results: Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively).

Conclusions: We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.

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