Antibiotics Do Not Reduce Risk of Death in Patients Hospitalized With Respiratory Infections

The importance of antimicrobial stewardship (coordinated efforts to promote appropriate antibiotic usage) has heightened in the years since the outbreak of COVID-19. Approximately 70% of COVID-19 patients were prescribed antibiotics, even though only 10% had a justified need.

Instead of improving their COVID-19 disease, these antibiotics may have enabled dangerous pathogens to develop resistance to antimicrobials.

Today, many patients admitted to the hospital with acute respiratory infections are still given antibiotics. Respiratory infections account for 10% of the global disease burden, and these patients are the most likely to be prescribed antibiotics.

A new study, released early from the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023), found that antibiotic therapy is unlikely to save lives of adults hospitalized with common viral respiratory infections.

“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 coinfections may be exaggerated,” said lead author Magrit Jarlsdatter Hovind of Akershus University Hospital and the University of Oslo, Norway.

“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.”

Hovind and her team conducted a retrospective analysis of antibiotic therapy of mortality in 2111 adult patients admitted to Akershus University Hospital in Oslo, Norway. Included patients had a nasopharyngeal or throat swab that was positive for influenza virus (H3N2, H1N1, influenza B; 44%, 935/2111), respiratory syncytial virus (RSV; 20%, 429/2111), or COVID-19 (35%, 747/2111) between 2017-2021. Excluded patients were those with a confirmed bacterial pathogen or other infection requiring antibiotic therapy.

The investigators found that antibiotic therapy was prescribed to 55% (1153/2111) of patients with viral respiratory infections upon hospital admission. An additional 168 patients were prescribed antibiotics later during hospitalization, for a total of 63% (1321/2111) of patients with respiratory infections receiving antibiotics during their hospital stay.

Within 30 days, 8% (168/2111) of patients died. Among them, 119 were prescribed antibiotics at admission, 27 were given antibiotics later in their hospital stay, and 22 were not prescribed any antibiotics during hospitalization.

After adjusting the results for virus type, sex, age, disease severity, and existing comorbidities, the investigators found that patients prescribed antibiotics at any point during their hospital stay (including admission) were twice as likely to die within 30 days as those not prescribed antibiotics. Additionally, mortality risk increased by 3% for each day of antibiotic therapy, compared to the cohort not given antibiotics.

“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,” 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.”