Characteristics of COVID‐19 patients with bacterial coinfection admitted to the hospital from the emergency department in a large regional healthcare system

Abstract

Introduction: The rate of bacterial coinfection with SARS-CoV-2 is poorly defined.The decision to administer antibiotics early in the course of SARS-CoV-2 infection depends on the likelihood of bacterial coinfection.Methods: We performed a retrospective chart review of all patients admitted through the emergency department with confirmed SARS-CoV-2 infection over a 6-week period in a large healthcare system in the United States. Blood and respiratory culture results were abstracted and adjudicated by multiple authors. The primary outcome was the rate of bacteremia. We secondarily looked to define clinical or laboratory features associated with bacteremia.Results: There were 542 patients admitted with confirmed SARS-CoV-2 infection, with an average age of 62.8 years. Of these, 395 had blood cultures performed upon admission, with six true positive results (1.1% of the total population). An additional 14 patients had positive respiratory cultures treated as true pathogens in the first 72 h. Low blood pressure and elevated white blood cell count, neutrophil count, blood urea nitrogen, and lactate were statistically significantly associated with bacteremia. Clinical outcomes were not statistically significantly different between patients with and without bacteremia. Conclusions:We found a low rate of bacteremia in patients admitted with confirmed SARS-CoV-2 infection. In hemodynamically stable patients, routine antibiotics may not be warranted in this population.

A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future

“…Specific bacteria commonly cited as causative agents of secondary infections included Staphylococcus spp. 9,10,[14][15][16][17][18]20,23,[27][28][29][30][31][32][33] , Streptococcus spp. 9,10,[15][16][17][18]20,23,27,29,34 , Escherichia coli 9,14,16,27,28,30,31,33,34 , Klebsiella spp.…”

“…The most commonly reported antibiotics in the literature reviewed were beta-lactams, macrolides and fluroquinolones 7,15,23,30 , in addition to piperacillin-tazobactam 9,23,24,26,29,30 and ceftriaxone 9,26,29,30,32 ; however, a wide range was reported (Table 2 and Table 3).…”

Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Fourteen studies [6,10,18,20,27,28,32,34,35,38,42,46,50,55] reported data on mortality in patients with COVID-19 and BSI. The pooled estimated occurrence of mortality (at the longest available follow-up) was 41% (95% CI 30%-52.8%; 189/482 patients; I 2 = 78%; Figure 3).…”

Prevalence of primary bacterial co-infections among patients with COVID-19 in Brunei Darussalam

“…The authors screened 80 (14.7%) of 542 patients with COVID-19 for primary bacterial respiratory co-infection, of whom 15 (2.8%) were treated as having true primary respiratory co-infections, defined as any infection identified within 72 hour of admission. ( 9 ) Although we did not screen patients for viral co-infection, the rate has been reported to be 1.5–3.0%. ( 2 , 10 , 11 ) Respiratory syncytial virus and influenza A are the two most common, with detection rates of 16.9% and 15.5%, respectively.…”