Evaluation of empirical antibacterial treatments of coronavirus disease 2019 patients diagnosed with community-acquired pneumonia

Due to similar clinical and radiological signs, empirical antibacterial therapy for bacterial community-acquired pneumonia (b-CAP) is commonly ordered in hospitalized patients with Coronavirus Disease 2019 (COVID-19) pneumonia. This study aimed to evaluate empirical antibacterial use for b-CAP in COVID-19 patients. Patients and methods This study was conducted as a prospective, observational and single-center study in a tertiary university hospital between March 2020 and April 2021. Patients aged ≥18 years, diagnosed with b-CAP, and had a positive polymerase chain reaction (PCR) test result for COVID-19 were included in the study. In addition, with negative PCR tests but diagnosed presumptively based on characteristic chest computed tomography findings and/or positive anti-SARSCoV2 IgM antibody were also followed up as COVID-19 patients. Risk factors and outcomes for empirical antibacterial usage in patients diagnosed with COVID-19 pneumonia were evaluated by examining biochemical and clinical parameters. The study protocol was approved by the local Ethics Committee (GO 22/520). Results 409 patients (262 with positive PCR for COVID-19 and 147 with positive computerized tomography (CT) imaging despite negative PCR for COVID-19) were included. Total of 205 (50.1%) patients received initial empirical antibacterial for suspected b-CAP. Antibacterial use was similar in patients with positive and negative PCR for COVID-19 (p = 0.947). However, antibacterial use was significantly higher in severe patients with a positive PCR for COVID-19 than in severe patients with a negative PCR (64.9% versus 59.5%; p < 0.001). Patients with high procalcitonin and C-reactive protein levels, leukocytosis, oxygen demand, and fever were more likely to receive empirical antibacterial therapy (Table 1). In multivariate analysis, it was shown that antibacterial therapy increased mortality risk 6.383 times. Nephrotoxicity was significantly higher in patients with an antibacterial treatment than in antibacterial-free patients (18.0% vs. 4.4%; p < 0.001). Conclusion Clinical improvement was similar in patients who received and did not receive empiric antibacterial. In addition, antibacterial-related adverse effects and mortality were higher in patients receiving antibacterial therapy. Evaluating antibacterial treatments in COVID-19 patients would be beneficial, mainly due to avoiding non-rational antibacterial use.