Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics.

Background During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical. Methods We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations. Results Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5–5.0, P  < 0.001 and OR 1.4, 95% CI 0.8–2.5, P  = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8–2.3, P  = 0.30 and OR 1.1, 95% CI 0.6–1.9, P  = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2–1.1, P  = 0.079 and OR 0.75, 95% CI 0.3–2.0, P  = 0.55, respectively); and length of hospital stay before and after weighting (mean difference −0.02 ± 0.5 days, P  = 0.97 and mean difference 0.54 ± 0.75 days, P  = 0.48, respectively). Conclusions We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]