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All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort.
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.
  • Schons MJ; Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
  • Caliebe A; Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
  • Spinner CD; Kiel University, Kiel, Germany.
  • Classen AY; School of Medicine, Department of Internal Medicine II, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany.
  • Pilgram L; Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
  • Ruethrich MM; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
  • Rupp J; Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany.
  • Nunes de Miranda SM; Institute for Infection Medicine and Hospital Hygiene, University Hospital Jena, Jena, Germany.
  • Römmele C; University Hospital Schleswig-Holstein, Lübeck, Germany.
  • Vehreschild J; Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
  • Jensen BE; Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany.
  • Vehreschild M; Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
  • Degenhardt C; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
  • Borgmann S; Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany.
  • Hower M; Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
  • Hanses F; Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany.
  • Haselberger M; Municipal Hospital Karlsruhe, Karlsruhe, Germany.
  • Friedrichs AK; Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany.
Infection ; 50(2): 423-436, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1460516
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antimicrobial Stewardship / COVID-19 Drug Treatment Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Humans Language: English Journal: Infection Year: 2022 Document Type: Article Affiliation country: S15010-021-01699-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antimicrobial Stewardship / COVID-19 Drug Treatment Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Humans Language: English Journal: Infection Year: 2022 Document Type: Article Affiliation country: S15010-021-01699-2