Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study
<b>Background:</b> 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 con...
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MDPI AG
2025-06-01
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| Online Access: | https://www.mdpi.com/2079-6382/14/6/594 |
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| author | Elisabeth Papiol Julen Berrueta Juan Carlos Ruíz-Rodríguez Ricard Ferrer Sara Manrique Laura Claverias Alejandro García-Martínez Pau Orts Emili Díaz Rafael Zaragoza Marco Marotta María Bodí Sandra Trefler Josep Gómez Ignacio Martín-Loeches Alejandro Rodríguez |
| author_facet | Elisabeth Papiol Julen Berrueta Juan Carlos Ruíz-Rodríguez Ricard Ferrer Sara Manrique Laura Claverias Alejandro García-Martínez Pau Orts Emili Díaz Rafael Zaragoza Marco Marotta María Bodí Sandra Trefler Josep Gómez Ignacio Martín-Loeches Alejandro Rodríguez |
| author_sort | Elisabeth Papiol |
| collection | DOAJ |
| description | <b>Background:</b> 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. <b>Objective:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, <i>p</i> = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, <i>p</i> = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, <i>p</i> < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, <i>p</i> = 0.03) compared to inappropriate EAT. <b>Conclusions:</b> 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. |
| format | Article |
| id | doaj-art-45e9c7e7b7c749e6837148c85bf30c97 |
| institution | Kabale University |
| issn | 2079-6382 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Antibiotics |
| spelling | doaj-art-45e9c7e7b7c749e6837148c85bf30c972025-08-20T03:32:28ZengMDPI AGAntibiotics2079-63822025-06-0114659410.3390/antibiotics14060594Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective StudyElisabeth Papiol0Julen Berrueta1Juan Carlos Ruíz-Rodríguez2Ricard Ferrer3Sara Manrique4Laura Claverias5Alejandro García-Martínez6Pau Orts7Emili Díaz8Rafael Zaragoza9Marco Marotta10María Bodí11Sandra Trefler12Josep Gómez13Ignacio Martín-Loeches14Alejandro Rodríguez15Intensive Care Department, Vall d’Hebron Universitary Hospital, 08035 Barcelona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainIntensive Care Department, Vall d’Hebron Universitary Hospital, 08035 Barcelona, SpainIntensive Care Department, Vall d’Hebron Universitary Hospital, 08035 Barcelona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainCritical Care Department, Hospital Parc Tauli, 08208 Sabadell, SpainCritical Care Department, Hospital Dr. Peset, 46017 Valencia, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, SpainTechnical Secretary Hospital Universitari Joan XXIII, 43005 Tarragona, SpainDepartment of Anaesthesia and Critical Care, Multidisciplinary Intensive Care Research Organization (MICRO), St James’s University Hospital, Trinity Centre for Health Sciences, D08 NHY5 Dublin, IrelandCritical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain<b>Background:</b> 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. <b>Objective:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, <i>p</i> = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, <i>p</i> = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, <i>p</i> < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, <i>p</i> = 0.03) compared to inappropriate EAT. <b>Conclusions:</b> 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.https://www.mdpi.com/2079-6382/14/6/594empirical antibiotic treatmentpandemic viral pneumoniaventilator-associated pneumoniaICU mortalityantimicrobial stewardship |
| spellingShingle | Elisabeth Papiol Julen Berrueta Juan Carlos Ruíz-Rodríguez Ricard Ferrer Sara Manrique Laura Claverias Alejandro García-Martínez Pau Orts Emili Díaz Rafael Zaragoza Marco Marotta María Bodí Sandra Trefler Josep Gómez Ignacio Martín-Loeches Alejandro Rodríguez Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study Antibiotics empirical antibiotic treatment pandemic viral pneumonia ventilator-associated pneumonia ICU mortality antimicrobial stewardship |
| title | Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study |
| title_full | Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study |
| title_fullStr | Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study |
| title_full_unstemmed | Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study |
| title_short | Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study |
| title_sort | does empirical antibiotic use improve outcomes in ventilated patients with pandemic viral infection a multicentre retrospective study |
| topic | empirical antibiotic treatment pandemic viral pneumonia ventilator-associated pneumonia ICU mortality antimicrobial stewardship |
| url | https://www.mdpi.com/2079-6382/14/6/594 |
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