Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study
Papiol, Elisabeth (Universitat Autònoma de Barcelona)
Berrueta, Julen (Hospital Universitari Joan XXIII de Tarragona)
Ruíz-Rodríguez, Juan Carlos (Hospital Universitari Vall d'Hebron)
Ferrer, Ricard (Universitat Autònoma de Barcelona. Departament de Medicina)
Claverias Cabrera, Laura (Hospital Universitari Joan XXIII de Tarragona)
García-Martínez, Alejandro (Hospital Universitari Joan XXIII de Tarragona)
Orts, Pau Macip (Hospital Universitari Joan XXIII de Tarragona)
Díaz, Emili (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Zaragoza, Rafael (Hospital Universitari Doctor Peset (València))
Marotta, Marco (Hospital Universitari Joan XXIII de Tarragona)
Bodí, María (Hospital Universitari Joan XXIII de Tarragona)
Trefler, Sandra (Hospital Universitari Joan XXIII de Tarragona)
Gómez, Josep (Hospital Universitari Joan XXIII de Tarragona)
Martín-Loeches, Ignacio (St James's University Hospital)
Rodríguez, Alejandro (Hospital Universitari Joan XXIII de Tarragona)

Data:	2025
Resum:	Background: During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. Objective: To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI. Methods: This retrospective analysis combined two national multicentre ICU registries in Spain, including 4197 adult patients requiring invasive mechanical ventilation for influenza A(H1N1) or COVID-19 between 2009 and 2021. Primary outcomes were ICU mortality and VAP incidence. Analyses were stratified by microbiologically confirmed bacterial COI. Propensity score matching, Cox regression, General Linear (GLM), and random forest models were applied. Results: Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1. 02, 95%CI 0. 81-1. 28, p = 0. 87) or VAP (OR = 1. 02, 95%CI 0. 79-1. 39, p = 0. 89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17. 4% vs. 36. 3%, p < 0. 001) and ICU mortality (38. 4% vs. 49. 6%, OR = 1. 89, 95%CI 1. 13-3. 14, p = 0. 03) compared to inappropriate EAT. Conclusions: EAT was not associated with a lower incidence of VAP or higher survival rates and could be harmful if administered incorrectly. These findings support a more targeted approach to antibiotic use, guided by microbiology, biomarkers and stewardship principles.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Empirical antibiotic treatment ; Pandemic viral pneumonia ; Ventilator-associated pneumonia ; ICU mortality ; Antimicrobial stewardship
Publicat a:	Antibiotics, Vol. 14 Núm. 6 (June 2025) , ISSN 2079-6382

DOI: 10.3390/antibiotics14060594
PMID: 40558184

20 p, 3.9 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d’Investigació i Innovació Parc Taulí (I3PT)
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