Open Access

Maximilian J. Schons, Amke Caliebe, Christoph D. Spinner, Annika Y. Classen, Lisa Pilgram, Maria M. Ruethrich, Jan Rupp, Susana Nunes de Miranda, Christoph Römmele, Janne Vehreschild, Bjoern-Erik Jensen, Maria Vehreschild, Christian Degenhardt, Stefan Borgmann, Martin Hower, Frank Hanses, Martina Haselberger, Anette K. Friedrichs, Julia Lanznaster, Christoph D. Spinner, Maria Madeleine Ruethrich, Bjoern-Erik Jensen, Martin Hower, Jan Rupp, Christoph Roemmele, Maria Vehreschild, Christian Degenhardt, Stefan Borgmann, Frank Hanses, Kerstin Hellwig, Jürgen vom Dahl, Sebastian Dolff, Christiane Piepel, Jan Kielstein, Silvio Nadalin, Marc Neufang, Milena Milovanovic, Kai Wille, Katja Rothfuss, Lukas Eberwein, Wolfgang Rimili, Timm Westhoff, Maximilian Worm, Gernot Beutel, Norma Jung, Joerg Schubert, Philipp Markart, Jessica Rueddel, Ingo Voigt, Robert Bals, Claudia Raichle, Jörg Janne Vehreschild, Carolin E. M. Jakob, Lisa Pilgram, Melanie Stecher, Maximilian Schons, Susana Nunes de Miranda, Nick Schulze, Sandra Fuhrmann, Clara Brünn, Annika Claßen, Bernd Franke, Fabian Praßer, Martin Lablans

• 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 secondaryPurpose 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.…