The Impact of Early Antibiotic Use on Clinical Outcomes of Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis.

<bold>Background:</bold> Early empiric antibiotics were prescribed to numerous patients during the Coronavirus disease 2019(COVID-19) pandemic. However, the potential impact of empiric antibiotic therapy on the clinical outcomes of patients hospitalized with COVID-19 is yet unknown. <bold>Methods:</bold> We conducted a retrospective cohort study in West China Hospital of Sichuan University between Dec 2022 to Mar 2023. The 1:2 propensity-score-matched(PSM) patient populations were further developed to adjust confounding factors. Results: We included a total of 1472 COVID-19 hospitalized patients, of whom 87.4% (1287 patients) received early antibiotic prescriptions. In PSM datasets, our analysis comprised 139 patients with non-antibiotic-use(with 278 matched controls) and 27 patients with deferred-antibiotic-use(with 54 matched controls). Patients with older ages, multiple comorbidities, severe and critical COVID-19 subtypes, higher serum infection indicators and inflammatory indicators at admission were more likely to receive early antibiotic prescriptions. After adjusting factors influencing the prognosis, no significant difference in mortality(HR=1.000(0.246-4.060), p=1.000) and ICU admission(HR=0.436(0.093-2.04), p=0.293), mechanical ventilation(HR=0.723(0.296-1.763), p=0.476) and tracheal intubation(HR=1.338(0.221-8.103), p=0.751) were observed between early-antibiotics-use cohort and non-antibiotic-use cohort. <bold>Conclusions:</bold> Early antibiotics were frequently prescribed to patients in more severe disease condition at admission. However, early antibiotic treatment failed to demonstrate better clinical outcomes in hospitalized patients with COVID-19 in the PSM cohorts.