Antibiotic therapy in severe COVID-19 between march 2020 and july 2022 and correlations with outcome in an intensive care unit in central Italy

Background and Objective: COVID-19 can evolve into severe clinical manifestations requiring hospitalization in intensive care unit (ICU) where antibiotic therapy is extensively undertaken. Antimicrobials use was evaluated in relation to the outcomes (transfer in other wards/death) in COVID-19 patients in ICU between May 2020-July 2022 in Molise region, central Italy. Methods: Data were obtained from clinical records and internal ward software. A descriptive and univariate analysis was performed through SPSS v28.0 setting p2 antibiotics, and a significant relation with outcome was observed, as 86% and 98% deaths occurred among who took ≤2 and >2 antibiotics, respectively. Further differences were found between outcome and treatment with azithromycin, meropenem, ceftaroline, linezolid and teicoplanin. Polypharmacotherapy with ≥3 antibiotics was more common in male patients (81.3% vs 18.7%), while no differences with respect of age <65 and ≥65 years emerged. Conclusions: Most patients were male who had largely received polypharmacotherapy due to high predisposition to severe COVID-19 according to national studies. Azithromycin did not show effects on disease evolution, and none of the broad-spectrum therapies had a significant impact on clinical improvements. The association between death and minor drug intake should be considered in the light of the complexity of patients and underlying diseases, suggesting a marginal impact of antibiotic therapy on COVID-19 outcomes.