Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection

Townsend, Liam; Hughes, Gerard; Kerr, Colm; Kelly, Mary; O'Connor, Ròisìn; Sweeney, Eileen C.; Doyle, Caitriona; O’Riordan, Ruth M.; Martín‐Loeches, Ignacio; Bergin, Colm; Bannan, Ciarán

doi:10.1093/jacamr/dlaa071

Cited by 59 publications

(55 citation statements)

References 12 publications

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“…Most included studies were from Asian countries, which might explain the relatively high proportion of Acinetobacter infection. Hugh et al [15] and Townsend et al [16] showed more similarities with the present study.…”

Section: Discussionsupporting

confidence: 90%

Pulmonary bacterial infections in patients hospitalized for COVID-19: a retrospective observational study

Husain

Valayer

Poey

et al. 2021

Preprint

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Backround During the COVID-19 pandemic, antibiotics use was very common. However, bacterial co/secondary infections with coronaviruses remain largely unknown, especially outside of intensive care. The aim of this study was to investigate the pulmonary bacterial infections characteristics associated with COVID-19 in hospitalized patients. Methods A retrospective monocentric observational study was conducted in Bichat hospital in France, between February 26 and April 22, 2020. All patients hospitalized in standard wards with COVID-19 (positive nasopharyngeal PCR and/or typical aspect on CT scan) and diagnosed with a pulmonary bacterial infection (positive bacteriological samples) were included. Bacteriological and clinical data were collected from the microbiology laboratories and the patient's medical records. Results Twenty-three bacteriological samples from 22 patients were positive out of 2075 screened samples (1.1%) from 784 patients (2.8%). Bacterial infection occurred with a median of ten days after COVID-19 onset. Diagnosis of pulmonary bacterial infection was suspected on the increase of oxygen requirements (20/22), productive cough or modification of sputum (17/22), or fever (10/22). Positive samples included 13 sputum cultures, one Film Array® on sputum, one bronchoalveolar lavage, six blood cultures and two pneumococcal antigenuria. The most frequent bacteria were Pseudomonas aeruginosa (6/23), Staphylococcus aureus (5/23), Streptococcus pneumoniae (4/23), Enterococcus faecalis (3/23) and Klebsiella aerogenes (3/23). No Legionella antigenuria was positive. Four out of 496 nasopharyngeal PCR (0.8%) were positive for intracellular bacteria (two Bordetella pertussis and two Mycoplasma pneumonia). Conclusions Pulmonary bacterial secondary infections and co-infections with SARS-CoV-2 are uncommon. Antibiotic use should remain limited in the management of COVID-19.

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Section: Discussionsupporting

confidence: 90%

Pulmonary bacterial infections in patients hospitalized for COVID-19: a retrospective observational study

Husain

Valayer

Poey

et al. 2021

Preprint

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“…In this COVID-19 pandemic, Yang and colleagues have reported that hospital-acquired pneumonia (HAP) was found in around 11.5% COVID-19 patients, which is in line with our results (9.5%), and bacterial co-infection is a major inducer of death as it could eventually lead to many organs and system failures, including sever bacterial pneumonia, sepsis, and bacterial meningitis [ 19 ]. Also, many other studies reconfirmed the vital phenomenon that the antibiotic resistance could occur in COVID-19 patients with bacterial co-infection [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 92%

Clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection: A multi-center study

Liu

Jiang

et al. 2021

PLoS ONE

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Objective To understand the clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection (CDBC), and therefore contributing to their early identification and prognosis estimation. Method 905 COVID-19 patients from 7 different centers were enrolled. The demography data, clinical manifestations, laboratory results, and treatments were collected accordingly for further analyses. Results Around 9.5% of the enrolled COVID-19 patients were diagnosed with CDBC. Older patients or patients with cardiovascular comorbidities have increased CDBC probability. Increased body temperature, longer fever duration, anhelation, gastrointestinal symptoms, illness severity, intensive care unit attending, ventilation treatment, glucocorticoid therapy, longer hospitalization time are correlated to CDBC. Among laboratory results, increased white blood cell counting (mainly neutrophil), lymphocytopenia, increased procalcitonin, erythrocyte sedimentation rate, C-reaction protein, D-dimer, blood urea nitrogen, lactate dehydrogenase, brain natriuretic peptide, myoglobin, blood sugar and decreased albumin are also observed, indicating multiple system functional damage. Radiology results suggested ground glass opacity mixed with high density effusion opacities and even pleural effusion. Conclusion The aged COVID-19 patients with increased inflammatory indicators, worse lymphopenia and cardiovascular comorbidities are more likely to have clinically diagnosed bacterial co-infection. Moreover, they tend to have severer clinical manifestations and increased probability of multiple system functional damage.

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“…The practice was that antimicrobial treatment was continued after positive SARS-CoV-2 PCR testing and the absence of evidence of bacterial infections in the majority of patients. Overall, the median duration of treatments with antimicrobials in the mentioned research was seven days [ 44 ].…”

Section: Antibiotic Prescribing For Covid-19 and The Unnecessary Umentioning

confidence: 99%

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

Rušić

Vilović

Bukic

et al. 2021

Life

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The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.

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Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection

Cited by 59 publications

References 12 publications

Pulmonary bacterial infections in patients hospitalized for COVID-19: a retrospective observational study

Pulmonary bacterial infections in patients hospitalized for COVID-19: a retrospective observational study

Clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection: A multi-center study

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

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