The effect of antibiotic therapy on clinical outcome in patients hospitalized with moderate COVID-19 disease: a prospective multi-center cohort study

PURPOSE: The benefit of antibiotic treatment (ABT) for patients with moderate COVID-19 is unclear and overtreatment poses the risk of adverse effects such as Clostridioides difficile infection and antibiotic resistance. This multi-center study compares health status improvement between patients with and without ABT at hospital admission. METHODS: Between March 2020 and May 2023, hospitalized adults with confirmed SARS-CoV-2 infection were recruited from the German National Pandemic Cohort Network (NAPKON), which includes patients from various hospitals across Germany. The study population included patients with moderate or severe COVID-19 at baseline. The primary objective was to compare health improvement or decline after two weeks between patients who received ABT at baseline and those who did not in the moderate COVID-19 population. The statistical analysis adjusted for confounders such as gender, age, vaccination status, clinical condition, and comorbidities. The severe COVID-19 population was investigated as a secondary objective. RESULTS: A total of 1,317 patients (median age 59 years; 38% women) were eligible for analysis, of whom 1,149 had moderate and 168 severe COVID-19 disease. ABT for pneumonia was administered to 467 patients with moderate and 117 with severe COVID-19. ABT at baseline was significantly associated with a higher deterioration rate after two weeks in patients with moderate COVID-19 (ABT: 292 improvement, 61 deterioration; no ABT: 429 improvement, 14 deterioration). A similar result was obtained in the multiple regression analysis where an odds ratio of 5.00 (95% confidence interval: 2.50 - 10.93) for ABT was observed. CONCLUSION: We found no benefit of antibiotic therapy in patients with moderate COVID-19. Use of ABT was associated with a higher likelihood of clinical deterioration.

• Friedrichs, A.
• Wenz, R.
• Pape, D.
• Appel, K. S.
• Bahmer, T.
• Becker, K.
• Bercker, S.
• Blaschke, S.
• Braunsteiner, J.
• Butzmann, J.
• Dahl, E.
• Erber, J.
• Fricke, L.
• Geisler, R.
• Göpel, S.
• Güldner, A.
• Hagen, M.
• Hamprecht, A.
• Hansch, S.
• Heuschmann, P. U.
• Hopff, S.
• Jensen, B. O.
• Käding, N.
• Koepsell, J.
• Koll, C. E. M.
• Krawczyk, M.
• Lücke, T.
• Meybohm, P.
• Milovanovic, M.
• Mitrov, L.
• Nürnberger, C.
• Römmele, C.
• Scherer, M.
• Schmidbauer, L.
• Stecher, M.
• Tepasse, P. R.
• Teufel, A.
• Vehreschild, J. J.
• Winter, C.
• Witzke, O.
• Wyen, C.
• Hanses, F.
• Caliebe, A.