Bacterial infections and patterns of antibiotic use in patients with COVID‐19

Abstract

Introduction Bacterial coinfection is associated with poor outcomes in patients with viral pneumonia, but data on its role in the mortality of patients with COVID‐19 is limited. Methods This is a single‐center retrospective analysis of 242 patients with confirmed coronavirus disease 2019 (COVID‐19) admitted to both intensive care and non‐intensive care settings. Bacterial coinfection was determined by the presence of characteristic clinical features and positive culture results. Multivariable logistic regression was used to analyze the association of concomitant bacterial infection with inpatient death after adjusting for demographic factors and comorbidities. Antibiotic use pattern was also determined. Results Bacterial coinfection was detected in 46 (19%) patients. Genitourinary source was the most frequent, representing 57% of all coinfections. The overall mortality rate was 21%. Concomitant bacterial infections were independently associated with increased inpatient mortality (OR: 5.838; 95% CI: 2.647‐12.876). Patients with bacterial coinfection were relatively older (71.35±11.20 vs. 64.78±15.23; p 0.006%). 67% of patients received antibiotic therapy, yet 72% did not have an obvious source of bacterial infection. There was a significantly higher rate of inpatient mortality in patients who received antibiotics compared to those who did not (30% vs. 5%; p<0.0001). Conclusion Bacterial coinfection in COVID‐19 is associated with increased mortality. This article is protected by copyright. All rights reserved.

Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19

“…While our finding suggests that antibiotics does not improve patient outcomes, it is still possible that a higher prevalence of antibiotic administration in severe and critical patients could worsen inflammation. 42 Finally, gut microbiota composition is highly heterogeneous across human populations and changes in compositions reported here may not necessarily be reflected in patients with COVID-19 from other biogeographies. Nevertheless, this survey of gut microbiota alterations in association with immune dysregulation revealed that gut microorganisms are likely involved in the modulation of host inflammatory responses in COVID-19.…”

Functional immunoparalysis characterized by elevated Interleukin-10 and Interleukin-10- to-Lymphocyte Count Ratio is associated with severe disease and poor outcomes in coronavirus disease 2019 (COVID-19)

“…This finding suggests a direct clinical consequence of functional immunoparalysis in some patients with severe COVID-19 driven by high IL-10 blunting a pro-inflammatory antimicrobial response with low lymphocyte count impairing adaptive immunity. In general, secondary infections are associated with increased morbidity and mortality in viral respiratory infections, including COVID-19 [28][29][30]. In a comprehensive meta-analysis, Langford et al reported a prevalence rate of 14.3% (95%CI: 9.6-18.9%) for secondary bacterial infections in patients with COVID-19 [31].…”

Severity of COVID-19 at elevated exposure to perfluorinated alkylates

“…Substantial differences occur in the clinical course of the disease, and the reasons for this variability are only partially known [ 15 , 16 ]. As a possible contributor, a deficient antibody response may be an important contributor to a more severe clinical course of the infection [ 17 ], as also suggested by the poorer prognosis in patients with bacterial co-infection [ 18 ]. The most serious clinical consequences are associated with male sex, older age, and the presence of co-morbidities, including obesity and diabetes [ 19 – 23 ].…”