Utilization of Antibiotics for Hospitalized Patients with Severe Coronavirus Disease 2019 in Al-Madinah Al-Munawara, Saudi Arabia: A Retrospective Study

BACKGROUND: Most patients admitted to intensive care units (ICUs) with severe Corona Virus Disease 2019 (COVID-19) pneumonia receive antibacterial antibiotics with little evidence of bacterial infections. OBJECTIVE: This study was designed to review the profiles of patients with severe COVID-19 pneumonia requiring intensive care, the rate of bacterial coinfection, the antibiotics used, and their relation to patient outcomes (death or recovery). METHODS: This was a retrospective study that reviewed the medical records of all patients with confirmed COVID-19 (n = 120) severe pneumonia admitted directly from the emergency room to the intensive care unit, at a public hospital during the period from May 2020 to April 2021. The data collected included patients’ demographic and laboratory data, comorbidities, antibiotic treatment, and their outcome. Descriptive statistics, bivariate inferential analysis tests (chi-square and unpaired T-Tests) and multivariable binary logistic regression were performed. RESULTS: The mean age of the patients was 56.8 ± 16.5 years old, and among them, 74 (62.7%) were males. Of the included patients, 92 (77.0%) had comorbidities, 76 (63.3%) required mechanical ventilation and 30 (25%) died. All patients received empirical antibiotics for suspected bacterial coinfection. The most common antibiotics used were azithromycin (n = 97, 8%) and imipenem (n = 83, 9%). Ninety patients (75%) were on two empirical antibiotics. Early positive cultures for pathogens were found only in four patients (3.3%), whereas 36 (30%) patients had positive cultures 5–10 days after admission. The most frequently isolated pathogens were Acinetobacter baumannii (n = 16) and coagulase-negative Staphylococci (n = 14). In bivariate analysis empirical treatment with azithromycin resulted in a significantly lower mortality rate (p = 0.023), meanwhile mechanical ventilation, days of stay in intensive care unit, morbidities (e.g., lung disease), linezolid and, vancomycin use associated with mortality (p< 0.05). The adjusted logistic regression, controlling for age and gender, revealed that azithromycin antibiotic was more likely protective from mortality (OR= 0.22, 95%CI 0.06-0.85, p=0.028. However, patients with lung diseases and under mechanical ventilation were 35.21 and 19.57 more likely to die (95%CI =2.84-436.70, p=0.006; 95%CI=2.66-143.85, p=0.003, respectively). CONCLUSION: Bacterial coinfection with severe COVID-19 pneumonia requiring intensive care was unlikely. The benefit of Azithromycin over other antibiotics could be attributed to its anti-inflammatory properties rather than its antibacterial effect.