Association Between Early Antibiotic Therapy and In-Hospital Mortality Among Older Patients With SARS-CoV-2 Pneumonia.
J Gerontol A Biol Sci Med Sci
; 77(4): e115-e123, 2022 04 01.
Article
in English
| MEDLINE | ID: covidwho-1316817
ABSTRACT
BACKGROUND:
It is uncertain whether antibiotic therapy should be started in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. We aimed to investigate the association between early antibiotic therapy and the risk of in-hospital mortality in older patients.METHODS:
We performed a retrospective international cohort study (ANTIBIOVID) in 5 coronavirus disease 2019 geriatric units in France and Switzerland. Among 1357 consecutive patients aged 75 or older hospitalized and testing positive for SARS-CoV-2, 1072 had radiologically confirmed pneumonia, of which 914 patients were still alive and hospitalized at 48 hours. To adjust for confounders, a propensity score for treatment was created, and stabilized inverse probability of treatment weighting (SIPTW) was applied. To assess the association between early antibiotic therapy and in-hospital 30-day mortality, SIPTW-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed.RESULTS:
Of the 914 patients with SARS-CoV-2 pneumonia, median age of 86, 428 (46.8%) received antibiotics in the first 48 hours after diagnosis. Among these patients, 147 (34.3%) died in hospital within 1 month versus 118 patients (24.3%) with no early antibiotic treatment. After SIPTW, early antibiotic treatment was not significantly associated with mortality (adjusted hazard ratio, 1.23; 95% confidence interval, 0.92-1.63; p = .160). Microbiologically confirmed superinfections occurred rarely in both groups (bacterial pneumonia 2.5% vs 1.5%, p = .220; blood stream infection 8.2% vs 5.2%, p = .120; Clostridioides difficile colitis 2.4% vs 1.0%, p = .222).CONCLUSIONS:
In a large multicenter cohort of older inpatients with SARS-CoV-2 pneumonia, early antibiotic treatment did not appear to be associated with an improved prognosis.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
SARS-CoV-2
/
COVID-19 Drug Treatment
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Aged
/
Humans
Language:
English
Journal:
J Gerontol A Biol Sci Med Sci
Journal subject:
Geriatrics
Year:
2022
Document Type:
Article
Affiliation country:
Gerona
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