How Necessary Is Empirical Antibiotic Therapy in COVID-19 Patients before ICU infections develop? An Observational Study

Introduction: There have been few studies reporting empirical antibiotic use in Covid-19 patients, particularly in those admitted to the intensive care unit (ICU). This study evaluated empirical antibiotic use in patients admitted to the ICU with Covid-19 
Methods: This two-center retrospective study included 79 consecutive patients who were admitted to the ICU due to Covid-19 infection between October 1 and December 31, 2020, and received empirical antibiotics. The patients were classified into two groups: those who developed ICU infections after 48 hours of ICU admission despite empirical antibiotic therapy (Group 1), and those who received empirical antibiotic therapy during the ICU stay, but were free of ICU infections (Group 2). 
Results: In Group 1, 37 patients (46.8%) developed ICU infections after a median of 12 days (IQR 5.5-15.5) of ICU stay. The cumulative antibiotic use until the detection ICU infections was 395 antibiotic days corresponding to 1070 DOTs/1000 hospital days. The median antibiotic use was 9 days (IQR 4-15.5). In Group 2, 42 patients (53.2%) received empirical antibiotic therapy for a median of 5 ICU days (IQR 3-8.3) and for a total of 256 antibiotic days (1051 DOTs/1000 hospital days). Twenty–three patients received empirical antibiotic therapy during the entire ICU stay. The median ICU stay was 6.5 days (IQR 4-10) and the median antibiotic use was 5 days (IQR 3-8.2). 
Discussion and Conclusion: Our findings are alarming and raise doubt about the potential role of antibiotics in the initial therapy of Covid-19 patients at the time of ICU admission and suggest the need to narrow or tailor antibiotic use based on clear laboratory and radiologic indications.