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Fear of bacterial co-infections in viral diseases may be exaggerated: Researchers

Despite the fact that the majority of patients admitted to the hospital with acute viral respiratory infections are given antibiotics as a standard procedure, researchers from a new observational study believe that the fear of bacterial co-infections is overblown, as prescribing antibiotic therapy to adults hospitalised with common viral respiratory infections such as influenza is unlikely to save lives.

The study's findings, which will be presented at this year's European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen, Denmark, in April 2023, indicate that antibiotics do not reduce the risk of death in adults hospitalised with common respiratory infections.

“Lessons from the COVID19 pandemic suggest that antibiotics can safely be withheld in most patients with viral respiratory infections, and that fear of bacterial co-infections may be exaggerated,” lead author Dr Magrit Jarlsdatter Hovind from Akershus University Hospital and the University of Oslo, Norway said.

“Our new study adds to this evidence, suggesting that giving antibiotics to people hospitalised with common respiratory infections is unlikely to lower the risk of death within 30 days. Such a high degree of potentially unnecessary prescribing has important implications given the growing threat of antimicrobial resistance.”

Pointing out that respiratory infections account for around 10% of the global disease burden and are the most common reason for prescribing antibiotics, the researchers stated that m many infections are viral and do not require or respond to antibiotics, but concerns about bacterial co-infection often lead to precautionary antibiotic prescribing.

In their analysis, Norwegian researchers retrospectively assessed the impact of antibiotic therapy on mortality in 2,111 adults admitted to Akershus University Hospital with a nasopharyngeal or throat swab at hospital admittance that was positive for influenza virus (H3N2, H1N1, influenza B; 44%, 935/2,111), respiratory syncytial virus (RSV; 20%, 429/2,111) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 35%, 747/2,111) between 2017 and 2021.

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The study found that while 55% of the patients with viral respiratory infections received antibiotics at the time of admission, in total 63% of the virally infected patients were given antibiotics at some point during their hospital stay.

Of the 168 or 8% of the patients who died within 30 days, 119 were given antibiotics at the time of admission while 27 patients were given antibiotics later during their hospital stay, and 22 patients did not receive any antibiotics, the study revealed.

Analyses revealed that patients given antibiotics at any point during their hospital stay were twice as likely to die within 30 days as those who were not, and the risk of death increased by 3% for each day of antibiotic therapy compared to those who were not.

However, according to the researchers, initiating antibiotics at hospital admission was not associated with an increased risk of death within 30 days.

“Although the analyses were adjusted for disease severity and underlying disease, this paradoxical finding may still be due to an antibiotic prescription pattern where the sicker patients and those with more underlying illnesses were both more likely to get antibiotics and to die”, explains Dr Hovind.

“Reducing the use and duration of in-hospital antibiotic therapy in patients with viral respiratory infections would reduce the risk of side effects from antibiotic exposure and help tackle the growing threat of antibiotic resistance,” she added.

“However, more robust evidence is needed from prospective randomised trials to determine whether patients admitted to hospital with viral respiratory infections should be treated with antibiotics,” Dr Hovind pointed out.

Noting some limitations in their study, the authors stated that they cannot prove causation and that while virus type, age, gender, and underlying illnesses were accounted for in the analysis, other unreported factors, such as smoking and socioeconomic background, could have influenced the outcome.

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