Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy
Alejandro David Bendala Estrada, Jorge Calderón Parra, Eduardo Fernández Carracedo, Antonio Muiño Míguez, António Ramos, Elena Múñez, Manuel Rubio‐Rivas, Paloma Agudo, Francisco Arnalich, Vicente Estrada Pérez, María Luisa Taboada Martínez, Anxela Crestelo Vieitez, Paula María Pesqueira Fontán, Marta Bustamante, Santiago Jesús Camacho Freire, Isabel Oriol, Arturo Artero, Julián Olalla, María Areses Manrique, Francisco Javier Carrasco-Sánchez, Vanessa Carolina Vento, Gema María García García, Pablo Cubero-Moráis, José Manuel Casas Rojo, Jesús Millán Núñez-Cortés
Abstract
BACKGROUND: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. METHODS: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. RESULTS: Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21-1.62; p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64-0.76; p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. CONCLUSIONS: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.