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Volume 14
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10.3390/antibiotics14060594
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Article

Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study

by
Elisabeth Papiol
1,2,3,
Julen Berrueta
4,5,
Juan Carlos Ruíz-Rodríguez
1,2,3,
Ricard Ferrer
1,2,3,
Sara Manrique
4,
Laura Claverias
4,
Alejandro García-Martínez
4,5,
Pau Orts
4,5,
Emili Díaz
6,
Rafael Zaragoza
7,
Marco Marotta
4,8,
María Bodí
4,8,9,10,
Sandra Trefler
4,
Josep Gómez
11,
Ignacio Martín-Loeches
12 and
Alejandro Rodríguez
4,9,10,13,* on behalf of the GETGAG and COVID-19 Working Group from SEMICYUC
1
Intensive Care Department, Vall d’Hebron Universitary Hospital, 08035 Barcelona, Spain
2
Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Research Institute (VHIR), 08035 Barcelona, Spain
3
Faculty of Medical Sciences, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
4
Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
5
Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain
6
Critical Care Department, Hospital Parc Tauli, 08208 Sabadell, Spain
7
Critical Care Department, Hospital Dr. Peset, 46017 Valencia, Spain
8
Medicine Department, Rovira i Virgili University, 43002 Tarragona, Spain
9
Pere Virgili Health Research Institute, 43005 Tarragona, Spain
10
Centre for Biomedical Research Network Respiratory Diseases (CIBERES), 43005 Tarragona, Spain
11
Technical Secretary Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
12
Multidisciplinary Intensive Care Research Organization (MICRO), Department of Anaesthesia and Critical Care, St James’s University Hospital, Trinity Centre for Health Sciences, D08 NHY5 Dublin, Ireland
13
Basic Sciences Department, Rovira I Virgili University, 43002 Tarragona, Spain
 
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*
Author to whom correspondence should be addressed.
Antibiotics 2025, 14(6), 594; https://doi.org/10.3390/antibiotics14060594 (registering DOI)
Submission received: 21 May 2025 / Revised: 3 June 2025 / Accepted: 7 June 2025 / Published: 8 June 2025
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
Versions Notes

Abstract

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.
Keywords: empirical antibiotic treatment; pandemic viral pneumonia; ventilator-associated pneumonia; ICU mortality; antimicrobial stewardship empirical antibiotic treatment; pandemic viral pneumonia; ventilator-associated pneumonia; ICU mortality; antimicrobial stewardship

Share and Cite

MDPI and ACS Style

Papiol, E.; Berrueta, J.; Ruíz-Rodríguez, J.C.; Ferrer, R.; Manrique, S.; Claverias, L.; García-Martínez, A.; Orts, P.; Díaz, E.; Zaragoza, R.; et al. Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study. Antibiotics 2025, 14, 594. https://doi.org/10.3390/antibiotics14060594

AMA Style

Papiol E, Berrueta J, Ruíz-Rodríguez JC, Ferrer R, Manrique S, Claverias L, García-Martínez A, Orts P, Díaz E, Zaragoza R, et al. Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study. Antibiotics. 2025; 14(6):594. https://doi.org/10.3390/antibiotics14060594

Chicago/Turabian Style

Papiol, Elisabeth, Julen Berrueta, Juan Carlos Ruíz-Rodríguez, Ricard Ferrer, Sara Manrique, Laura Claverias, Alejandro García-Martínez, Pau Orts, Emili Díaz, Rafael Zaragoza, and et al. 2025. "Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study" Antibiotics 14, no. 6: 594. https://doi.org/10.3390/antibiotics14060594

APA Style

Papiol, E., Berrueta, J., Ruíz-Rodríguez, J. C., Ferrer, R., Manrique, S., Claverias, L., García-Martínez, A., Orts, P., Díaz, E., Zaragoza, R., Marotta, M., Bodí, M., Trefler, S., Gómez, J., Martín-Loeches, I., & Rodríguez, A., on behalf of the GETGAG and COVID-19 Working Group from SEMICYUC. (2025). Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study. Antibiotics, 14(6), 594. https://doi.org/10.3390/antibiotics14060594

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