Presumptive antibiotics offer few benefits in ICU COVID-19

  • Buetti N & al.
  • J Infect
  • 5 Jun 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Pre-ICU-admission antibiotics do not appear to affect presumptive bacterial superinfection or mortality in patients with COVID-19.
  • Large multicenter studies are needed.

Why this matters

  • The paucity of data for bacterial coinfection in COVID-19 patients suggests that presumptive use of broad-spectrum antimicrobials may only contribute to antibiotic resistance while providing no real clinical benefit.

Key results

  • 48 ICU patients, median age 66.5 (interquartile range [IQR], 60-71) years.
  • 40% (19) received antibiotics before admission, most frequently amoxicillin/clavulanate (66%, 13).
  • Patients receiving antibiotics were more frequently women (32% vs 17% without) and receiving coadministered antivirals (68% vs 48% without).
  • Mortality rates were similar between groups (26% with antibiotics vs 24% without; P=.86).
  • No difference seen in health care-associated infections (median infection number/patient: IQR, 1 [1-2] both; P=.98).
  • Most common infections: urinary tract infection (10.5% with vs 27.6% without), candidemia (15.8% with vs 6.9% without).

Study design

  • Retrospective analysis of the effect of early antibiotic therapy on mortality, delayed severe health care-associated infections in intubated patients with COVID-19, Switzerland.
  • Funding: Swiss National Science Foundation.

Limitations

  • Retrospective. 
  • Small sample.