Wendel Garcia, Pedro DavidCeccato, AdrianMotos, AnaFranch Llasat, DiegoPérez Moreno, Ma. del Mar OlgaDomenech Spanedda, Marie F.Chamarro Martí, ElenaFerrer, RicardFernández Barat, LaiaRiera, JordiÁlvarez Napagao, SergioPeñuelas, OscarLorente, J. A. (José Ángel)Almansa, RaquelGabarrús, AlbertGonzalo Calvo, David deGonzález, JessicaAñon, Jose ManuelBarberà, CarmeBarberán, JoséBlandino Ortiz, AaronBustamante Munguira, ElenaCaballero, JesúsCarbajales Pérez, CristinaCarbonell, NievesCatalán González, MercedesBarral Segade, PatriciaMañez, RafaelTorre, Maria del Carmen de laDíaz, EmiliEstella, ÁngelGallego, ElenaGarcía Garmendia, José LuísGarnacho Montero, JoséAmaya Villar, RosarioGómez, José M.Huerta, ArturoJorge García, Ruth NoemíLoza vázquez, AnaMarin Corral, JudithMartin Delgado, María CruzMartínez de la Gándara, AmaliaMartínez Varela, IgnacioLópez Messa, JuanMuñiz Albaiceta, GuillermoNovo, Mariana AndreaPeñasco, YhivianPozo Laderas, Juan CarlosRicart, PilarSánchez Miralles, AngelSancho, SusanaSocias, LorenzoSolé Violán, JordiSuárez Sipmann, FernandoTamayo, LuisTrenado Álvarez, JoséBarbé, FerranTorres Martí, AntoniRoche Campo, FerranCIBERESUCICOVID investigators2025-04-292025-04-292025-02-010163-4453https://hdl.handle.net/2445/220685Background: Bacterial pulmonary superinfections develop in a substantial proportion of mechanically ventilated COVID-19 patients and are associated with prolonged mechanical ventilation requirements and increased mortality. Albeit recommended, evidence supporting the use of empirical antibiotics at intubation is weak and of low quality. The aim of this study was to elucidate the effect of empirical antibiotics, administered within 24 h of endotracheal intubation, on superinfections, duration of mechanical ventilation, and mortality in mechanically ventilated patients with COVID-19. Methods: Emulated targeted trial by means of a propensity score-matched analysis of a prospective multicentre cohort study of consecutive mechanically ventilated patients admitted to 62 Spanish intensive care units suffering from COVID-19 between March 2020 and February 2021. Results: Overall, 8532 critically ill COVID-19 patients were included, of which 2580 mechanically ventilated patients remained after matching. Empirical antibiotics were prescribed to 1665 (64%) at intubation. Pulmonary superinfections developed in 39% and 47% of patients treated with and without empirical antibiotics, respectively (p < 0.01). Patients treated with empirical antibiotics had a shorter duration of mechanical ventilation (incidence risk ratio: 0.85 [95% confidence interval (CI), 0.78 - 0.94], p < 0.01) and a reduced stay in the intensive care unit (incidence risk ratio: 0.89 [95% CI, 0.82 - 0.97] days, p < 0.01). Mortality 28 days after endotracheal intubation was 28% in patients treated with empirical antibiotics as opposed to 32% in patients treated without (odds ratio: 0.76 [95% CI, 0.61 - 0.94], p < 0.01). Conclusion: The administration of empirical antibiotics at intubation in mechanically ventilated COVID-19 patients was associated with a reduced incidence of pulmonary superinfections, a shorter duration of mechanical ventilation and intensive care unit stay, and a lower mortality rate. Notwithstanding these benefits, the applicability of these findings to other viral pneumonias and beyond the pandemic context remains uncertain. Registration: www.clinicaltrials.gov (NCT04457505).12 p.application/pdfengcc-by (c) Wendel Garcia, Pedro David et al., 2025http://creativecommons.org/licenses/by/3.0/es/AntibiòticsPneumòniaRespiració artificialAntibioticsPneumoniaArtificial respirationinfo:eu-repo/semantics/article2025-04-03info:eu-repo/semantics/openAccess39814268