All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort

the LEOSS Study Group

doi:10.1007/s15010-021-01699-2

All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort

the LEOSS Study Group

Clinic of Infectious Diseases and Microbiology

7 Citations (Scopus)

Abstract

Purpose: Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods: 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results: Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). Conclusion: In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.

Original language	English
Journal	Infection
Volume	50
Issue number	2
Pages (from-to)	423-436
Number of pages	14
ISSN	0300-8126
DOIs	https://doi.org/10.1007/s15010-021-01699-2
Publication status	Published - 04.2022

Funding

The LEOSS registry was supported by the German Centre for Infection Research (DZIF) and the Willy Robert Pitzer Foundation. We express our gratitude to all study teams that supported the LEOSS study. The following study teams contributed at least five per thousand to the analyses of this study: Klinikum Passau (Martina Haselberger), Technische Universität München (Christoph D. Spinner), Universitätsklinikum Jena (Maria Madeleine Ruethrich), Universitätsklinikum Düsseldorf (Bjoern-Erik Jensen), Klinikum Dortmund gGmbH (Martin Hower), Universitätsklinikum Schleswig-Holstein—Lübeck (Jan Rupp), Universitätsklinikum Augsburg (Christoph Roemmele), Universitätsklinikum Frankfurt (Maria Vehreschild), Städtisches Klinikum Karlsruhe (Christian Degenhardt), Klinikum Ingolstadt (Stefan Borgmann), Universitätsklinikum Regensburg (Frank Hanses), Katholisches Klinikum Bochum (St. Josef-Hospital) Ruhr-Universität Bochum (Kerstin Hellwig), Kliniken Maria Hilf GmbH Mönchengladbach (Jürgen vom Dahl), Universitätsklinikum Essen (Sebastian Dolff), Klinikum Bremen-Mitte (Christiane Piepel), Klinikum Braunschweig (Jan Kielstein), Universitätsklinikum Tübingen (Siri Göpel), Evangelisches Stadtkrankenhaus Saarbrücken (Marc Neufang), Malteser Krankenhaus St. Franziskus Hospital Flensburg (Milena Milovanovic), Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum (Kai Wille), Robert-Bosch-Krankenhaus Stuttgart (Katja Rothfuss), Klinikum Leverkusen (Lukas Eberwein), Kreuznacher Diakonie Hunsrück (Wolfgang Rimili), Marien Hospital Herne, Ruhr-Universität Bochum (Timm Westhoff), Oberlausitz Kliniken (Maximilian Worm), Medizinische Hochschule Hannover (Gernot Beutel), Universitätsklinikum Köln (Norma Jung), Elblandklinikum Riesa (Joerg Schubert), Klinikum Fulda (Philipp Markart), Sophien- und Hufeland Klinikum Weimar (Jessica Rueddel), Elisabeth-Krankenhaus Essen (Ingo Voigt), Universitätsklinikum des Saarlandes (Homburg) (Robert Bals), Tropenklinik Paul-Lechler Krankenhaus Tübingen (Claudia Raichle) The infrastructure group of the LEOSS study: Jörg Janne Vehreschild (Goethe-Universität Frankfurt), Carolin E. M. Jakob (Universitätsklinikum Köln), Lisa Pilgram (Goethe-Universität Frankfurt), Melanie Stecher (Universitätsklinikum Köln), Maximilian Schons (Universitätsklinikum Köln), Susana Nunes de Miranda (Universitätsklinikum Köln), Nick Schulze (Universitätsklinikum Köln), Sandra Fuhrmann (Universitätsklinikum Köln), Clara Brünn (Universitätsklinikum Köln), Annika Claßen (Universitätsklinikum Köln), Bernd Franke (Universitätsklinikum Köln), Fabian Praßer (Charité, Universitätsmedizin Berlin) und Martin Lablans (Universitätsklinikum Mannheim). The LEOSS registry was supported by the German Centre for Infection Research (DZIF) and the Willy Robert Pitzer Foundation. Open Access funding enabled and organized by Projekt DEAL. This analysis received no financial support. LEOSS was financially supported by the Willy Robert Pitzer Foundation and the German Centre for Infection Research (DZIF).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Academic Focus: Center for Infection and Inflammation Research (ZIEL)

DFG Research Classification Scheme

2.21-03 Medical Microbiology and Mycology, Hygiene, Molecular Infection Biology
2.22-31 Clinical Infectiology and Tropical Medicine

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10.1007/s15010-021-01699-2

Cite this

@article{41a97fc68ec34a38b7eea559dcf1f7c8,

title = "All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort",

abstract = "Purpose: Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods: 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results: Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). Conclusion: In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.",

author = "\{the LEOSS Study Group\} and Schons, \{Maximilian J.\} and Amke Caliebe and Spinner, \{Christoph D.\} and Classen, \{Annika Y.\} and Lisa Pilgram and Ruethrich, \{Maria M.\} and Jan Rupp and \{Nunes de Miranda\}, \{Susana M.\} and Christoph R{\"o}mmele and Janne Vehreschild and Jensen, \{Bjoern Erik\} and Maria Vehreschild and Christian Degenhardt and Stefan Borgmann and Martin Hower and Frank Hanses and Martina Haselberger and Friedrichs, \{Anette K.\} and Julia Lanznaster and Ruethrich, \{Maria Madeleine\} and Jensen, \{Bjoern Erik\} and Martin Hower and Jan Rupp and Christoph Roemmele and Maria Vehreschild and Christian Degenhardt and Stefan Borgmann and Frank Hanses and Kerstin Hellwig and Dahl, \{J{\"u}rgen vom\} and Sebastian Dolff and Christiane Piepel and Jan Kielstein and Silvio Nadalin and Marc Neufang and Milena Milovanovic and Kai Wille and Katja Rothfuss and Lukas Eberwein and Wolfgang Rimili and Timm Westhoff and Maximilian Worm and Gernot Beutel and Norma Jung and Joerg Schubert and Philipp Markart and Jessica Rueddel and Ingo Voigt and Robert Bals and Claudia Raichle",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2022",

month = apr,

doi = "10.1007/s15010-021-01699-2",

language = "English",

volume = "50",

pages = "423--436",

journal = "Infection",

issn = "0300-8126",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "2",

}

TY - JOUR

T1 - All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy

T2 - an analysis of the LEOSS cohort

AU - the LEOSS Study Group

AU - Schons, Maximilian J.

AU - Caliebe, Amke

AU - Spinner, Christoph D.

AU - Classen, Annika Y.

AU - Pilgram, Lisa

AU - Ruethrich, Maria M.

AU - Rupp, Jan

AU - Nunes de Miranda, Susana M.

AU - Römmele, Christoph

AU - Vehreschild, Janne

AU - Jensen, Bjoern Erik

AU - Vehreschild, Maria

AU - Degenhardt, Christian

AU - Borgmann, Stefan

AU - Hower, Martin

AU - Hanses, Frank

AU - Haselberger, Martina

AU - Friedrichs, Anette K.

AU - Lanznaster, Julia

AU - Ruethrich, Maria Madeleine

AU - Jensen, Bjoern Erik

AU - Hower, Martin

AU - Rupp, Jan

AU - Roemmele, Christoph

AU - Vehreschild, Maria

AU - Degenhardt, Christian

AU - Borgmann, Stefan

AU - Hanses, Frank

AU - Hellwig, Kerstin

AU - Dahl, Jürgen vom

AU - Dolff, Sebastian

AU - Piepel, Christiane

AU - Kielstein, Jan

AU - Nadalin, Silvio

AU - Neufang, Marc

AU - Milovanovic, Milena

AU - Wille, Kai

AU - Rothfuss, Katja

AU - Eberwein, Lukas

AU - Rimili, Wolfgang

AU - Westhoff, Timm

AU - Worm, Maximilian

AU - Beutel, Gernot

AU - Jung, Norma

AU - Schubert, Joerg

AU - Markart, Philipp

AU - Rueddel, Jessica

AU - Voigt, Ingo

AU - Bals, Robert

AU - Raichle, Claudia

PY - 2022/4

Y1 - 2022/4

N2 - Purpose: Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods: 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results: Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). Conclusion: In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.

AB - Purpose: Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods: 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results: Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). Conclusion: In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.

UR - https://www.scopus.com/pages/publications/85116835119

U2 - 10.1007/s15010-021-01699-2

DO - 10.1007/s15010-021-01699-2

M3 - Journal articles

C2 - 34625912

AN - SCOPUS:85116835119

SN - 0300-8126

VL - 50

SP - 423

EP - 436

JO - Infection

JF - Infection

IS - 2

ER -

All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort

Abstract

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

Access to Document

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