Antibiotics are prescribed to the majority of hospitalized patients with acute viral respiratory infections. Now, new research that will be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark, from April 15 to 18, suggests that it is unlikely to save lives to prescribe antibiotic therapy to adults who are hospitalized with common viral respiratory infections like influenza.
Lead author Dr. Magrit Jarlsdatter Hovind, of Akershus University Hospital and the University of Oslo, Norway, states, “Lessons from the COVID-19 pandemic suggest that antibiotics can safely be withheld in the majority of patients with viral respiratory infections and that fear of bacterial co-infections may be exaggerated.” This evidence is supported by our new study, which suggests that administering antibiotics to patients admitted to the hospital with common respiratory infections is unlikely to reduce the risk of death within 30 days. Given the growing threat of antimicrobial resistance, such a high rate of potentially unnecessary prescribing has significant implications.”
The most common reason for prescribing antibiotics is respiratory infection, which accounts for approximately 10% of the global disease burden. Although concerns about bacterial co-infection frequently lead to the prescribing of precautionary antibiotics, many infections are viral and do not require or respond to antibiotics.
“Our new study adds to this body of evidence, indicating that providing antibiotics to adults in the hospital with common respiratory infections is unlikely to reduce the chance of mortality within 30 days. Given the growing concern of antibiotic resistance, such a high level of potentially unneeded medication has significant implications.”
Dr. Magrit Jarlsdatter Hovind from Akershus University Hospital and the University of Oslo, Norway.
Antibiotics were used a lot in hospitals and the community due to concerns about COVID-19 and bacterial co-infection. According to studies, antibiotics were prescribed to approximately 70% of COVID-19 patients in some countries, despite the fact that their use was only justified in approximately 10% of cases [1].
With a nasopharyngeal or throat swab at hospital admission that was positive for influenza virus (H3N2, H1N1, influenza B), Norwegian researchers retrospectively assessed the impact of antibiotic therapy on mortality in 2,111 adults. respiratory syncytial virus (RSV; 44 percent, 935/2,111; 20 percent, 429/2,111); or the coronavirus that causes the severe acute respiratory syndrome (SARS-CoV-2; 747/2,111) from 2017 to 2021, or 35 percent.
Blood cultures and nasopharyngeal or throat swabs for common viral and bacterial pathogens were among the clinically routine tests performed during hospital admission for respiratory infections. This analysis did not include patients with other infections that required antibiotic treatment or those with a confirmed bacterial pathogen.
Over half (55 percent) received antibiotic treatment. 1153/2,111) of patients admitted to the hospital with viral respiratory infections. During their stay in the hospital, an additional 168 patients received antibiotics. During their time in the hospital, including their admission, 63% (1,322/2,111) of patients received antibiotics for respiratory infections (see the figures in the editors’ notes).
168 (8%) patients died within 30 days, including 119 who received antibiotics upon admission, 27 who received antibiotics during their stay, and 22 who were not given antibiotics.
Patients who were given antibiotics at any time during their hospital stay—including at admission—had a doubled risk of death within 30 days compared to those who were not given antibiotics, and the risk of mortality increased by 3% for each day that they were given antibiotics compared to those who were not given antibiotics. These findings were made after controlling for factors such as the type of virus, gender, age, severity of the disease, and underlying conditions. In contrast, there was no link between starting antibiotics right after admission to the hospital and an increased risk of 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 die,” Dr. Hovind explains. “Although the analyses were adjusted for disease severity and underlying disease,”
She goes on to say, “Reducing the use and duration of in-hospital antibiotic therapy in patients with viral respiratory infections would help tackle the growing threat of antibiotic resistance and reduce the risk of side effects from antibiotic exposure.” To determine whether patients admitted to the hospital with viral respiratory infections should be treated with antibiotics, more robust evidence from prospective randomized trials is needed.”
Although the type of virus, age, sex, and underlying illnesses were adjusted for in the analysis, there may have been other factors that were not reported, such as smoking and socioeconomic background, that influenced the outcome, according to the authors’ acknowledgement of the study’s limitations. Additionally, there were no data for biochemistry and biomarkers like creatinine, C-reactive protein (CRP), and white blood cells (WBC).
More information: [1] Steffanie A Strathdee et al, Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election, The Lancet (2020). DOI: 10.1016/S0140-6736(20)32063-8
