{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:36:25Z","timestamp":1785429385244,"version":"3.56.0"},"reference-count":51,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy, Timisoara","award":["5\/4270\/04.03.2025"],"award-info":[{"award-number":["5\/4270\/04.03.2025"]}]},{"award":["5\/4270\/04.03.2025"],"award-info":[{"award-number":["5\/4270\/04.03.2025"]}],"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Adults hospitalized with COVID-19, influenza A\/B, or respiratory syncytial virus (RSV) frequently receive empirical antibiotics, but antibiotic prescribing, confirmed bacterial co-infection, antimicrobial resistance (AMR), and outcomes have not been jointly synthesized across these infections. Methods: We conducted a PRISMA 2020 systematic review and meta-analysis of 39 studies including 839,531 hospitalized adults. Random-effects models with Freeman\u2013Tukey double-arcsine transformation pooled prevalence estimates; sensitivity and publication-bias analyses were performed where appropriate. Results: Pooled antibiotic use was 62.56% (95% CI, 53.75\u201370.97%) for COVID-19, 57.48% (25.76\u201386.09%) for influenza A\/B, and 76.03% (67.62\u201383.53%) for RSV, with very high heterogeneity. Confirmed bacterial co-infection was lower: 5.31% (3.43\u20137.56%), 18.66% (9.98\u201329.30%), and 24.36% (18.53\u201330.70%), respectively. Prescribing-to-confirmed infection ratios ranged from 3.0 to 46.2. AMR evidence was restricted to COVID-19 studies and was dominated by carbapenem-resistant Gram-negative organisms, mainly in secondary, ICU-associated, or healthcare-associated infections. Confirmed bacterial complications were associated with ICU admission, longer hospitalization, and higher mortality. Conclusions: Antibiotic prescribing exceeded confirmed bacterial infection across all viral groups, but estimates require cautious interpretation due to heterogeneity, diagnostic uncertainty, observational evidence, and the absence of low-risk-of-bias studies. The evidence base was dominated by COVID-19 cohorts, while influenza A\/B and RSV data, especially virus-specific AMR evidence, remain limited. COVID-19-specific AMR findings should not be generalized to influenza A\/B or RSV. Virus-specific stewardship should prioritize rapid diagnostics, systematic sampling, reassessment, and de-escalation when bacterial infection is not confirmed.<\/jats:p>","DOI":"10.3390\/antibiotics15070654","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:50:37Z","timestamp":1782867037000},"page":"654","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic Use, Bacterial Co-Infection, and Antimicrobial Resistance in Adults Hospitalized with COVID-19, Influenza, or RSV: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7865-9915","authenticated-orcid":false,"given":"Florina Cristiana","family":"Lucaciu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8236-2205","authenticated-orcid":false,"given":"Ovidiu","family":"Rosca","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6508-928X","authenticated-orcid":false,"given":"Ana 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Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8387-7700","authenticated-orcid":false,"given":"Madalina-Ianca","family":"Suba","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0749-8232","authenticated-orcid":false,"given":"Norbert","family":"Wellmann","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Center of Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2664-7645","authenticated-orcid":false,"given":"Alessia","family":"Rosian","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Oancea","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d, Gheorghe Adam Street 13, 300310 Timisoara, Romania"},{"name":"Center of Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor 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