Patients Hospitalized for COVID-19 Rarely Required Antibiotics

Patients hospitalized for COVID-19 were unlikely to develop a concurrent infectious disease or benefit from antibiotics, in the assessment of one hospital which restricts antibiotics from its COVID-19 treatment protocols absent symptoms suggestive of another infection.

In reviewing the literature before conducting their own study, Junpei Komagamine, MD and colleagues at the Tochigi Medical Center, Tochigi, Japan found that approximately 70% of patients hospitalized for COVID-19 receive antibiotics. They posited that the restrictions on antibiotics at their hospital provided an opportunity to examine the extent to which antibiotics are necessary.

"Data are needed on patients with COVID-19 infection who do not routinely receive an antimicrobial drug prescription, to identify the true rate of concurrent infection in this patient population," Komagamine and colleagues explained.

The investigators retrospectively examined the records for 1056 patients who were hospitalized for laboratory-confirmed COVID-19 infection in the period from November 1, 2020 to October 9, 2921. Their median age was 50 years (36-61); 669 were men (63.4%).COVID-19 symptoms were classified per WHO guidelines as mild in 50.9%, moderate in 29.6%, and severe in 19.2%. Onset of symptoms was a median 5 days (3-7) prior to admission.

Most (91.7%) had not been vaccinated against COVID-19. Underlying medical conditions included diabetes in 11.7% and congestive pulmonary disease or asthma in 7.9%. Fever was present on admission in 60.9%, and pneumonia developed in 48.7%. The median duration of hospitalization was 6 days (4-8). During hospitalization 9 patients (0.9%) died.

Although 104 patients (9.9%) had been prescribed antibiotics prior to admission, only 18 (1.5%) received any during hospitalization. Of the 18 patients, 15 were prescribed the antibiotic as active treatment, and 3 for prophylaxis. Microbiologically confirmed infectious diseases other than COVID-19 were detected in just 6 patients during hospitalization.

"The findings revealed that concurrent infectious diseases rarely occurred despite the infrequent use of antimicrobial drugs during hospitalization among patients with COVID-19," Komagamine and colleagues reported.

"Given that most patients with non-critical severity recovered without antimicrobial drugs, the use of most antimicrobial drugs to treat non-critical cases in many hospitals might be unnecessary," they suggest.

The investigators acknowledge that the retrospective data collection, single-center design and short-term follow-up could limit the applicability of their finding to other sites.In addition, they note that they had excluded patients (47) who were transferred to other hospitals for intensive care; and that the study population included few patients (1.4%) who were immunocompromised. They also note that a positive microbial test did not necessarily indicate a true infection.

They attribute the strengths and importance of the study to following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and assessing all antimicrobial drugs regardless of the reason for use; and finding an extremely low rate of use compared with that in previous studies.