Hazardous mismatch between pulmonary pathogens and antibiotic treatments in COVID-19 patients

Coppola, Silvia; Ciabattoni, Arianna; Pozzi, Tommaso; Castagna, V.; Bassi, Gianluigi Li; Chiumello, Davide

doi:10.1016/j.bja.2020.07.019

Cited by 8 publications

(15 citation statements)

References 10 publications

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“…Based on the finding that pulmonary bacterial superinfections seem to be mostly nosocomial, empirical broad-spectrum antimicrobial therapy could be stopped and only treated, if pathogenic bacteria are detected (12, 30). Future prospective, randomized trials to investigate the efficacy of targeted antimicrobial therapy should be conducted to define best practice regarding prevention and treatment of bacterial superinfections in COVD-19.…”

Section: Discussionmentioning

confidence: 99%

“…Data regarding bacterial superinfections in COVID-19 pneumonia are limited and still emerging (10, 11). A recent systematic review has concluded that the rate of bacterial/fungal superinfections is low arguing against the frequent use of broad-spectrum antimicrobials in patients with COVID-19 (10, 12). Still, there is a lack of knowledge about the frequency and significance of bacterial, fungal and viral concomitant infections in critically ill COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

“…Still, there is a lack of knowledge about the frequency and significance of bacterial, fungal and viral concomitant infections in critically ill COVID-19 patients. (12) Additionally, in most studies performed so far, no thorough and systematic sampling for concomitant infections was performed. The high mortality in severely ill COVID-19 patients is thought to be at least in part due to secondary infections in addition to viral replication in the lower respiratory tract leading to severe lung injury and ARDS (6, 13, 14).…”

Section: Introductionmentioning

confidence: 99%

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Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients

Buehler

Hofmaenner

García

et al. 2020

Preprint

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Objectives While superinfections are associated with unfavourable disease course, their impact on clinical outcomes in critically ill COVID-19 patients remains largely unknown. We aimed to investigate the burden of superinfections in COVID-19 patients. Methods In this prospective single centre cohort study in an intensive care setting patients aged ≥ 18 years with COVID-19 acute respiratory distress syndrome were assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages and blood. Our primary outcome was ventilator-free survival on day 28 in patients with and without clinically relevant superinfection. Further outcomes included the association of superinfection with ICU length of stay, incidence of bacteremia, viral reactivations, and fungal colonization. Results In 45 critically ill COVID-19 patients, we identified 19 patients with superinfections (42.2%) by longitudinal analysis of 433 TBS, 35 BAL and 455 blood samples, respectively. On average, superinfections were detected on day 10 after ICU admission. The most frequently isolated clinically relevant bacteria were Enterobacteriaceae, Streptococcus pneumoniae, and Pseudomonas aeruginosa. Ventilator-free survival was substantially lower in patients with superinfection (subhazard ratio 0.37, 95%-CI 0.15-0.90, p=0.028). Patients with pulmonary superinfections more often had bacteraemia, virus reactivations, yeast colonization, and needed ICU treatment for a significantly longer time. Conclusions The detection of superinfections was frequent and associated with reduced ventilator-free survival. Despite empirical antibiotic therapy, superinfections lead to an extended ICU stay in COVID 19 patients. Longitudinal microbiological sampling in COVID-19 patients could allow targeted antimicrobial therapy, and therefore minimize the use of broad-spectrum and reserve antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients

Buehler

Hofmaenner

García

et al. 2020

Preprint

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“…10,11 A recent systematic review has concluded that the rate of bacterial/fungal superinfections is low, arguing against the frequent use of broad-spectrum antimicrobials in patients with COVID-19. 11,12 However, COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in several cohorts of critically ill patients. 13,14 Still, there is a lack of knowledge about the frequency and significance of bacterial, fungal, and viral concomitant infections in critically ill COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients

Buehler

Zinkernagel

Hofmaenner

et al. 2021

Cell Reports Medicine

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The impact of secondary bacterial infections (superinfections) in COVID-19 is not well understood. In this prospective, monocentric cohort study we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days (VFDs) at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37, 95%-CI 0.15-0.90, p=0.028). Patients with pulmonary superinfections have a higher incidence of bacteraemia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy.

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“…As antibiotics are anticipated to have a marginal advantage as pragmatic therapy in COVID-19 treatment and results in auxiliary pernicious effects viz., toxicity, adverse events, antibiotic resistance, and Clostridioides difficile sepsis, it is advisable for clinicians to advocate them aptly [ [75] , [76] , [77] , [78] ]. Increasing the statistics of presumptuous stratagems linked with the prescription of antibiotics, immunomodulatory drugs such as steroidal anti-inflammatory drugs and overpopulated in clinics can contribute to an increase in nosocomial diseases.…”

Section: Introductionmentioning

confidence: 99%

Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world

Mazumder

Kalamdhad

Chaminda

et al. 2021

Case Studies in Chemical and Environmental Engineering

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In viral respiratory infections, bacterial co-pathogens are widely known to co-infect, and they significantly increase the morbidity and mortality rate. During the influenza season, the advent of 2019-nCoV (novel coronavirus) has led to the widespread use of oral and intravenous antibiotics and inhibitors of neuraminidase enzyme. Owing to causes such as extended intubation, the ubiquitous use of intrusive catheters, and compromised host immunity, coronavirus disease (COVID-19) patients are at heightened risk of secondary bacterial and fungal infections, leading to the difficulty in their treatment. Apart from the pandemic, the primary risk is a likely surge in multidrug resistance. In this work, we evaluated the coalescence of present co-infection alongside the COVID-19 and post-pandemic antimicrobial resistance due to high ongoing drug use for the treatment of COVID-19. We found that while there is currently limited evidence of bacterial infections in COVID-19, available proof supports the restricted use of antibiotics from an antibiotic stewardship viewpoint, primarily upon entry. Paramount attempts should be made to collect sputum and blood culture samples as well as pneumococcal urinary antigen monitoring in order to endorse stringent antibiotic usage. For antimicrobial stewardship, inflammatory markers like procalcitonin have been added, but such biomarkers are typically upraised in COVID-19. Antimicrobials cannot be completely removed in wastewater treatment plants (WWTPs) and once they enter the water environment, possesses great risk of inducing resistance to drugs in microbes. Hence, their prescription and administrations should be regulated and alternate solutions such as vaccines, preventive measures and personal hygiene should be given top priority. It is imperative to establish an antimicrobial strategy discrete to COVID-19, as this pandemic has caused outbreak of numerous other associated diseases and has the potential to drive microbial resistance. Coordinated plans are essential for this at the citizen, health-care and policy levels.

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Hazardous mismatch between pulmonary pathogens and antibiotic treatments in COVID-19 patients

Cited by 8 publications

References 10 publications

Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients

Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients

Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients

Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world

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