All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort

• Published in: Infection 2022-04, Vol.50 (2), p.423-436
• Main Authors: Schons, Maximilian J., Caliebe, Amke, Spinner, Christoph D., Classen, Annika Y., Pilgram, Lisa, Ruethrich, Maria M., Rupp, Jan, Nunes de Miranda, Susana M., Römmele, Christoph, Vehreschild, Janne, Jensen, Bjoern-Erik, Vehreschild, Maria, Degenhardt, Christian, Borgmann, Stefan, Hower, Martin, Hanses, Frank, Haselberger, Martina, Friedrichs, Anette K.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial Stewardship; Coronaviruses; COVID-19; COVID-19 Drug Treatment; Disease Progression; Family Medicine; General Practice; Humans; Infectious Diseases; Internal Medicine; Medicine; Medicine & Public Health; Mortality; Original Paper; Patients; Procalcitonin; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Superinfection; Viral diseases
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-021-01699-2

Purpose Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase ( n  = 996) (both p  > 0.05). For the secondary endpoints, patients in the uncomplicated phase ( n  = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics ( p  > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment ( n  = 286) had a significantly increased all-cause mortality ( p  = 0.029) but no significantly different probability of progression to the critical phase ( p  > 0.05). Conclusion In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.