By IDSE News Staff
Prescribing antibiotics to adults hospitalized with common viral respiratory tract infections (RTIs), such as influenza, is unlikely to reduce mortality, according to new research to be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark (abstract 2519).
Norwegian researchers retrospectively assessed the effect of antibiotic therapy on mortality in 2,111 adults admitted to Akershus University Hospital with a nasopharyngeal or throat swab at hospital admittance that was positive for influenza virus (H3N2, H1N1, influenza B; 44% [935/2,111]), respiratory syncytial virus (RSV; 20% [429/2,111]) or the COVID-19 virus (SARS-CoV-2; 35% [747/2,111]) between 2017 and 2021.
They reviewed the results of tests that were part of the clinical routine during hospital admittance with respiratory infections, which included blood cultures and nasopharyngeal or throat swabs for common viral and bacterial patho-gens. Patients with a confirmed bacterial pathogen or who had other infections requiring antibiotic therapy were excluded from the analysis.
Antibiotic therapy was initiated in more than half (55%; 1153/2,111) of patients with viral RTIs at admission to hospital. A further 168 patients were given antibiotics later during hospitalization. In total, 63% (1,321/2,111) of patients received antibiotics for RTIs during their hospital stay.
Overall, 168 (8%) patients died within 30 days: 119 patients prescribed antibiotics at admission, 27 patients given antibiotics later during their hospital stay, and 22 patients not prescribed antibiotics.
Respiratory infections account for about 10% of the global disease burden and are the most common reason for prescribing antibiotics, due to concerns about bacterial co-infection that often lead to precautionary antibiotic prescribing.
This concern during COVID-19 led to widespread use of antibiotics in hospitals and the community. Studies reported that in some countries, antibiotics were prescribed for around 70% of COVID-19 patients, even though their use was only justified in about one in 10 of them, according to lead author Magrit Jarlsdatter Hovind, MD, of Akershus Univer-sity Hospital and the University of Oslo, in Norway.
“Lessons from the COVID-19 pandemic suggest that antibiotics can safely be withheld in most patients with viral respiratory infections, and that fear of bacterial co-infections may be exaggerated,” she said. “Our new study adds to this evidence, suggesting that giving antibiotics to people hospitalized with common respiratory infections is unlikely to lower the risk of death within 30 days. Such a high degree of potentially unnecessary prescribing has important implications given the growing threat of antimicrobial resistance.”
In this study, analyses that adjusted for age, sex, virus type, severity of disease and underlying illnesses found that patients prescribed antibiotics at any time during their hospital stay (including at admission) were twice as likely to die within 30 days as those not given antibiotics, and the risk for death increased by 3% for each day of antibiotic therapy compared with those not given antibiotics. Initiating antibiotics at hospital admission was not associated with an increased risk for death within 30 days.
“Although the analyses were adjusted for disease severity and underlying disease, this paradoxical finding may still be due to an antibiotic prescription pattern where the sicker patients and those with more underlying illnesses were both more likely to get antibiotics and to die,” Dr. Hovind explained.
“Reducing the use and duration of in-hospital antibiotic therapy in patients with viral respiratory infections would reduce the risk of side effects from antibiotic exposure and help tackle the growing threat of antibiotic resistance. However, more robust evidence is needed from prospective randomized trials to determine whether patients admitted to hospital with viral respiratory infections should be treated with antibiotics.”
The researchers noted some limitations to their study, including that it is an observational study and cannot prove causation, and although age, sex, virus type and underlying illnesses were adjusted for in the analysis, there may have been other factors that were unreported, such as smoking and socioeconomic background, that may have influenced the outcome. In addition, data were not available on biochemistry/biomarkers such as white blood cell count, C-reactive protein and creatinine.
