ABSTRACT

Empirical antibiotic use is common in hospitalized patients with COVID-19 pneumonia because it is difficult to differentiate it from concurrent bacterial pneumonia. In this study, we investigated risk factors for concurrent bacterial community-acquired pneumonia (b-CAP) and the need for initial empirical antibiotic coverage when patients presented with pulmonary involvement caused by SARS CoV-2.

This study was conducted as a prospective observational study in a tertiary university hospital between March 2020 and April 2021. Patients over 18 years of age who were hospitalized with COVID-19 pneumonia were included. Risk factors and outcomes were compared between the patients who received initial empirical antibiotics and those who did not.

The presence of respiratory viral pathogens other than SARS CoV-2 was investigated via a respiratory panel multiplex polymerase chain reaction in 295 patients, and potential bacterial respiratory pathogens in 306 patients on admission to the hospital. Although the co-infection rate was low (17.4%), half of the patients (205/409, 50.1%) were administered initial empirical antibiotics for suspected concurrent b-CAP. Antibiotic use was higher in patients with multiple comorbidities, severe to critical pneumonia, and patients over 65 years (p<0.001). The overall 30-day mortality was significantly higher (26.3% and 2.0%, p<0.001), and the duration of hospital stay was longer (median 13.0 and 5.5 days, p<0.001) in patients who received empirical antibacterial agents.

Initial empirical antibiotic treatment is common in patients infected with SARS CoV-2, although the co-infection rate is low. Empirical antibiotic(s) did not improve the clinical course in COVID-19 patients.