High frequency of antibiotic administration for COVID-19 patients in Syria and its associations with mortality and complications

Journal article

Background: Syria’s healthcare system was severely challenged by the COVID-19 pandemic due to resource scarcity and a shortage of healthcare personnel. In this context, antibiotics were frequently prescribed empirically because of limited diagnostic capacity, concerns about secondary bacterial infections, and delayed hospitalization, despite the limited evidence of bacterial co-infection among patients with COVID-19. Method: This study investigates the use of antibiotics among hospitalized COVID-19 patients in Syria, focusing on its association with mortality, ICU admissions, and complications. We conducted a multicenter retrospective cohort study in the four major Syrian cities, including 3199 patients, 93.4% of whom received antibiotics. Results: The most frequently prescribed antibiotics were cephalosporins, macrolides, and quinolones. We found a significant association between the administration of multiple classes (> 3) of antibiotics and increased mortality and ICU admissions, even after adjusting for the LR-COMPAK mortality risk score and treating hospital. Specifically, the use of carbapenem, piperacillin/tazobactam, glycopeptides, and cephalosporins were independently linked to increased mortality, while piperacillin/tazobactam, carbapenem, glycopeptides, amoxicillin/clavulanate, cephalosporins, and quinolones were associated with ICU admissions. Administration of multiple classes (> 3) of antibiotics also correlated with complications including secondary infections, septic shock, and acute kidney injury. Conclusions: This study highlights excessive antibiotic use among hospitalized COVID-19 patients in Syria and its association with increased mortality, ICU admission, and serious complications. These findings underscore the urgent need for strengthened antibiotic stewardship and improved prescribing practices to reduce adverse outcomes and mitigate the growing threat of antimicrobial resistance in conflict-affected and resource-limited healthcare settings. Clinical trial number: Not applicable

Authors: Albdewi, MJ; Stimpson, E; Hanafi, I

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: BMC Infectious Diseases
• Volume: 25
• Issue: 1
• Article number: 1797
• Publication date: 2025-12-22
• Acceptance date: 2025-12-15
• DOI: 10.1186/s12879-025-12382-4
• EISSN: 1471-2334
• ISSN: 1471-2334
• Language: English
• Keywords: COVID-19; Complications; Antibiotics; Syria; Mortality