{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T02:56:31Z","timestamp":1775012191694,"version":"3.50.1"},"reference-count":16,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: COVID-19 imposes challenges in antibiotic decision-making due to similarities between bacterial pneumonia and moderate to severe COVID-19. We evaluated the effects of antibiotic therapy on the clinical outcomes of COVID-19 pneumonia patients and diagnostic accuracy of key inflammatory markers to inform antibiotic decision-making. Methods: An observational cohort study was conducted in patients hospitalised with COVID-19 at the National Centre for Infectious Diseases and Tan Tock Seng Hospital, Singapore, from January to April 2020. Patients were defined as receiving empiric antibiotic treatment for COVID-19 if started within 3 days of diagnosis. Results: Of 717 patients included, 86 (12.0%) were treated with antibiotics and 26 (3.6%) had documented bacterial infections. Among 278 patients with COVID-19 pneumonia, those treated with antibiotics had more diarrhoea (26, 34.7% vs. 24, 11.8%, p &lt; 0.01), while subsequent admissions to the intensive care unit were not lower (6, 8.0% vs. 10, 4.9% p = 0.384). Antibiotic treatment was not independently associated with lower 30-day (adjusted odds ratio, aOR 19.528, 95% confidence interval, CI 1.039\u2013367.021) or in-hospital mortality (aOR 3.870, 95% CI 0.433\u201334.625) rates after adjusting for age, co-morbidities and severity of COVID-19 illness. Compared to white cell count and procalcitonin level, the C-reactive protein level had the best diagnostic accuracy for documented bacterial infections (area under the curve, AUC of 0.822). However, the sensitivity and specificity were less than 90%. Conclusion: Empiric antibiotic use in those presenting with COVID-19 pneumonia did not prevent deterioration or mortality. More studies are needed to evaluate strategies to diagnose bacterial co-infections in these patients.<\/jats:p>","DOI":"10.3390\/antibiotics11020184","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T08:20:29Z","timestamp":1643617229000},"page":"184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When?"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4570-3266","authenticated-orcid":false,"given":"Tat Ming","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8570-436X","authenticated-orcid":false,"given":"Sean W. X.","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey Y. X.","family":"Loo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sock Hoon","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7672-4812","authenticated-orcid":false,"given":"Hui Lin","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9801-7219","authenticated-orcid":false,"given":"Min Yi","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Lye","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tau Hong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barnaby E.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"105955","DOI":"10.1016\/j.ijantimicag.2020.105955","article-title":"The epidemiology, diagnosis and treatment of COVID-19","volume":"55","author":"Zhai","year":"2020","journal-title":"Int. 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Care"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/2\/184\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:11:47Z","timestamp":1760134307000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/2\/184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,31]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["antibiotics11020184"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11020184","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,31]]}}}