Open Access

Anette Friedrichs, Roman Wenz, Daniel Pape, Katharina S. Appel, Thomas Bahmer, Karsten Becker, Sven Bercker, Sabine Blaschke, Josephine Braunsteiner, Jana Butzmann, Egdar Dahl, Johanna Erber, Lisa Fricke, Ramsia Geisler, Siri Goepel, Andreas Gueldner, Marina Hagen, Axel Hamprecht, Stefan Hansch, Peter U. Heuschmann, Sina Hopff, Björn-Erik Ole Jensen, Nadja Kaeding, Julia Koepsell, Carolin E. M. Koll, Marcin Krawczyk, Thomas Luecke, Patrick Meybohm, Milena Milovanovic, Lazar Mitrov, Carolin Nuernberger, Christoph Roemmele, Margarete Scherer, Lena Schmidbauer, Melanie Stecher, Phil-Robin Tepasse, Andreas Teufel, Joerg Janne Vehreschild, Christof Winter, Oliver Witzke, Christoph Wyen, Frank Hanses, Amke Caliebe

• 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-19Purpose 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.…