All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort
Authors: Schons Maximilian J. , Caliebe Amke , Spinner Christoph D. , Classen Annika Y. , Pilgram Lisa , Ruethrich Maria M. , Rupp Jan , Nunes de Miranda Susana M. , Römmele Christoph , Vehreschild Janne , Jensen Bjoern-Erik , Vehreschild Maria , Degenhardt Christian , Borgmann Stefan , Hower Martin , Hanses Frank , Haselberger Martina , Friedrichs Anette K. ,   the LEOSS-study group, Lanznaster Julia , Spinner Christoph D. , Ruethrich Maria Madeleine , Jensen Bjoern-Erik , Hower Martin , Rupp Jan , Roemmele Christoph , Vehreschild Maria , Degenhardt Christian , Borgmann Stefan , Hanses Frank , Hellwig Kerstin , Dahl Jürgen vom , Dolff Sebastian , Piepel Christiane , Kielstein Jan , Nadalin Silvio , Neufang Marc , Milovanovic Milena , Wille Kai , Rothfuss Katja , Eberwein Lukas , Rimili Wolfgang , Westhoff Timm , Worm Maximilian , Beutel Gernot , Jung Norma , Schubert Joerg , Markart Philipp , Rueddel Jessica , Voigt Ingo , Bals Robert , Raichle Claudia , Vehreschild Jörg Janne , Jakob Carolin E. M. , Pilgram Lisa , Stecher Melanie , Schons Maximilian , de Miranda Susana M. Nunes , Schulze Nick , Fuhrmann Sandra , Brünn Clara , Claßen Annika , Franke Bernd , Praßer Fabian , Lablans Martin 
Published: October 2021

Abstract
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 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.