Bacterial superinfection pneumonia in SARS-CoV-2 respiratory failure

Pickens, Chiagozie I; Gao, Catherine; Cuttica, Michael J.; Smith, Sean B.; Pesce, Lorenzo L.; Grant, Rogan A.; Kang, Mengjia; Morales‐Nebreda, Luisa; Bavishi, Avni; Arnold, Jason; Pawlowski, Anna; Qi, Chao; Budinger, G.S.; Singer, Benjamin D.; Wunderink, Richard G.; Investigators, NU Covid

doi:10.1101/2021.01.12.20248588

Cited by 20 publications

(22 citation statements)

References 36 publications

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“…Studies in which peripheral blood is serially sampled generally show resolution of these abnormalities over the course of the disease. However, it is important to note that high rates of ventilatorassociated pneumonia in patients with SARS-CoV-2 pneumonia (44% in our cohort) may confound these results (70).…”

Section: Similarities In Pneumonia Secondary To Sars-cov-2 Versus Other Respiratory Pathogensmentioning

confidence: 86%

“…In anticipation of the pandemic, we modified our bronchoscopy protocols to ensure operator safety. Our clinical teams performed bronchoscopies in patients with SARS-CoV-2 pneumonia, as clinically indicated, and used analysis of BAL fluid with quantitative bacterial cultures, multiplex PCR, and fungal antigens to guide antimicrobial therapy (28,70). We compared BAL fluid samples from patients with SARS-CoV-2 pneumonia with serial BAL fluid samples we collected from 211 patients with severe pneumonia secondary to other pathogens requiring mechanical ventilation before the pandemic.…”

Section: Studies Of Sars-cov-2 Pneumonia In Patientsmentioning

confidence: 99%

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Distinctive features of severe SARS-CoV-2 pneumonia

Budinger¹,

Misharin²,

Ridge³

et al. 2021

Journal of Clinical Investigation

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Section: Similarities In Pneumonia Secondary To Sars-cov-2 Versus Other Respiratory Pathogensmentioning

confidence: 86%

Section: Studies Of Sars-cov-2 Pneumonia In Patientsmentioning

confidence: 99%

Distinctive features of severe SARS-CoV-2 pneumonia

Budinger¹,

Misharin²,

Ridge³

et al. 2021

Journal of Clinical Investigation

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“…First, the circulating RAS may not reflect the local tissue levels, which may be particularly altered in the lungs in COVID-19 ( 17 ). An assessment of the lung compartment in COVID-19 is more challenging, though others have shown that bronchoalveolar lavage in patients with COVID-19 is feasible ( 18 ). Second, our study is likely underpowered to reveal true differences in circulating RAS components.…”

Section: Discussionmentioning

confidence: 99%

A pilot study to assess the circulating renin-angiotensin system in COVID-19 acute respiratory failure

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Gibbs

Schaich

et al. 2021

American Journal of Physiology-Lung Cellular and Molecular Phys

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The renin-angiotensin system (RAS) is fundamental to COVID-19 pathobiology, due to the interaction between the SARS-CoV-2 virus and the angiotensin-converting enzyme-2 (ACE2) co-receptor for cellular entry. The prevailing hypothesis is that SARS-CoV-2-ACE2 interactions lead to an imbalance of the RAS, favoring pro-inflammatory Ang II related signaling at the expense of the anti-inflammatory Ang-(1-7) mediated alternative pathway. Indeed, multiple clinical trials targeting this pathway in COVID-19 are underway. Therefore, precise measurement of circulating RAS components is critical to understand the interplay of the RAS on COVID-19 outcomes. Multiple challenges exist in measuring the RAS in COVID-19 including improper patient controls, ex-vivo degradation and low concentrations of angiotensins, and unvalidated laboratory assays. Here, we conducted a prospective pilot study to enroll thirty-three moderate and severe COVID-19 patients and physiologically matched COVID-19 negative controls to quantify the circulating RAS. Our enrollment strategy led to physiologic matching of COVID-19 negative and positive moderate hypoxic respiratory failure cohorts, in contrast to the severe COVID-19 cohort which had increased severity of illness, prolonged ICU stay and increased mortality. Circulating Ang II and Ang-(1-7) levels were measured in the low picomolar (pM) range. We found no significant differences in circulating RAS peptides or peptidases between these three cohorts. The combined moderate and severe COVID-19 positive cohorts demonstrated a mild reduction in ACE activity compared to COVID-19 negative controls (2.2±0.9x105 vs. 2.9±0.8x105 RFU/mL, p=0.03). These methods may be useful in designing larger studies to physiologically match patients and quantify the RAS in COVID-19 RAS augmenting clinical trials.

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“…A thorough search into the literature (January 2020–June 2021) revealed many studies trying to address the AMR issue in the pandemic era. The main issues refer to patients with COVID-19 who may receive antimicrobial therapy (a) without a microbiological confirmation of the bacterial co-infection [ 18 , 31 , 32 , 33 , 34 , 35 , 36 ] and (b) often in the absence of a microbiological confirmation of the diagnosis [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Lai et al [ 24 ] recorded the consumption of antibiotics in January–June 2019 vs. January–June 2020 in The National Taiwan University Hospital.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance—WHONET-Greece (January 2018–March 2021)

Polemis

Mandilara

Παππά

et al. 2021

Life

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Changes in hospitals’ daily practice due to COVID-19 pandemic may have an impact on antimicrobial resistance (AMR). We aimed to assess this possible impact as captured by the Greek Electronic System for the Surveillance of Antimicrobial Resistance (WHONET-Greece). Routine susceptibility data of 17,837 Gram-negative and Gram-positive bacterial isolates from blood and respiratory specimens of hospitalized patients in nine COVID-19 tertiary hospitals were used in order to identify potential differences in AMR trends in the last three years, divided into two periods, January 2018–March 2020 and April 2020–March 2021. Interrupted time-series analysis was used to evaluate differences in the trends of non-susceptibility before and after the changes due to COVID-19. We found significant differences in the slope of non-susceptibility trends of Acinetobacter baumannii blood and respiratory isolates to amikacin, tigecycline and colistin; of Klebsiella pneumoniae blood and respiratory isolates to meropenem and tigecycline; and of Pseudomonas aeruginosa respiratory isolates to imipenem, meropenem and levofloxacin. Additionally, we found significant differences in the slope of non-susceptibility trends of Staphylococcus aureus isolates to oxacillin and of Enterococcus faecium isolates to glycopeptides. Assessing in this early stage, through surveillance of routine laboratory data, the way a new global threat like COVID-19 could affect an already ongoing pandemic like AMR provides useful information for prompt action.

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Bacterial superinfection pneumonia in SARS-CoV-2 respiratory failure

Cited by 20 publications

References 36 publications

Distinctive features of severe SARS-CoV-2 pneumonia

Distinctive features of severe SARS-CoV-2 pneumonia

A pilot study to assess the circulating renin-angiotensin system in COVID-19 acute respiratory failure

COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance—WHONET-Greece (January 2018–March 2021)

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