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In
patients critically infected with COVID-19, early antibiotic therapy does not
affect mortality or delayed severe hospital-acquired infections.
The preliminary results of a recent study showed that early antibiotic therapy does not impact mortality or delay hospital-acquired infections in severe COVID-19 patients considerably.
A retrospective analysis was conducted to determine the impact of early administered antibiotics (i.e., before ICU, intensive care unit admission) on mortality and delayed severe healthcare-related infections in the ICU. All medical charts of intubated ICU patients admitted from 9 April 2020 to 20 May 2020, to a community hospital in the Southern part of Switzerland were retrospectively analyzed.
An examination of patients who received antibiotics and who were not administered antibiotics was carried out before ICU stay. Differences in mortality, CRBSIs (catheter-related bloodstream infections), UTIs (urinary tract infections), candidemias (i.e., outcomes), and VAP (ventilator-associated pneumonia) between both groups were evaluated.
Before ICU admission, antibiotics were given at the discretion of the attending physician, and this variable was regularly collected. For both groups, characteristics of patients were described as count (per cent) or median (IQR, interquartile range) for qualitative and quantitative variables, respectively. Using Chi-square, Fisher, or Mann–Whitney tests, a comparative evaluation was done.
The study enrolled 48 ICU patients infected with COVID-19. The median age was 66.5 ([IQR] 60 -71) and 33% (n=11) were females. In 19 patients (40%) antibiotics were administered before ICU admission. The suspected clinical indication in all the cases was a bacterial co-infection. Amoxicillin/clavulanate (68%, n=13) was the most frequently used antibiotic.
Similar patients’ characteristics were noted in both groups. It was observed that in patients without antibiotics the cardiovascular disease was more frequent (38%) and lesser (16%) in patients with antibiotics. Whereas women (32% versus 17% in patients without antibiotics) and antivirals (68% versus 48%) were more commonly witnessed in the group with antibiotics.
Both the groups depicted similar mortality. No difference in the number of delayed healthcare-associated infections during ICU stay was observed in both the groups but Candidemias found to be more frequent in the antibiotic group. On the other hand, UTI tended to be more frequent in the group without antibiotic as depicted in Table 1:
Due to the low number of patients included in the
analysis, a firm conclusion could not be illustrated. There is an urgent
requisition of large multi-centric randomized trials to examine the impact of
early antibiotics therapy on ICU complications (such as duration of mechanical
ventilation), mortality, and subsequent healthcare-related infections.
Thus,
there is no significant impact of early antibiotic therapy on mortality or
delayed hospital-acquired infections in critically ill COVID-19 patients.
Journal of Infection
Early administered antibiotics do not impact mortality in critically ill patients with COVID-19.
Niccolò Buetti et al.
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