Improving antibiotic stewardship in COVID-19: Bacterial co-infection is less common than with influenza

Youngs, Jonathan; Wyncoll, Duncan; Hopkins, Philip; Arnold, Amber; Ball, Jonathan; Bicanic, Tihana

doi:10.1016/j.jinf.2020.06.056

Cited by 63 publications

(79 citation statements)

References 4 publications

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“…Our data do not support the use of antimicrobials in COVID-19 unless a bacterial/fungal superinfection is suspected. This is now in accordance with more recent literature and updated guidelines for the treatment of COVID-19 [5,14,22]. Our data show a high incidence of VAP, with a strong predominance of gram negative bacteria, this is in accordance with previous reports of ICU patients with COVID-19 [15].…”

Section: Discussionsupporting

confidence: 93%

“…We observed a higher incidence of nosocomial infections compared to those reported in some recent meta-analysis [5,6,12]. However, when we compared our results with those of studies that only included COVID-19 patients hospitalized in the ICU, we observed more similar results [11,[13][14][15][16]. The occurrence of a nosocomial infection was a late complication, occurring after a median of more than one week of ICU stay.…”

Section: Discussionsupporting

confidence: 71%

“…The majority of our patients have also received courses of broad spectrum antibiotics, in several cases without a con rmed diagnosis of nosocomial infection, and despite this large antimicrobial coverage we recorded a high incidence of infections. Severe COVID-19 can easily mimic bacterial sepsis [14,29] and this has certainly led many physicians to prescribing antibiotic treatment which then has proven not to be justi ed. This result shows that, during the peak of the outbreak, the principles of antimicrobial stewardship were implemented less strictly, a problem which has been highlighted in the literature [20,21].…”

Section: Discussionmentioning

confidence: 99%

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Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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Background: Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients.Aim: To assess the characteristics and outcome of ICU-acquired infections in COVID-19 patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%) and urinary tract infection (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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“…Our ndings show a higher percentage of patients with bacterial and fungal growth in sputum cultures than some reports [24]. Our patients were sicker than in a study of hospitalised but not intubated patients and there was longer patient follow up [22].…”

Section: Discussioncontrasting

confidence: 43%

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Liu

Yaron

Piraino

et al. 2020

Preprint

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Background: Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. Methods: Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1,058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05.Results: Average patient age was 68.7 years. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall were evaluated and did not suggest acute bacterial or fungal infection in 89 (54%) of 165 individuals sampled within 24 hours of intubation. Cultures > one week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus.Conclusions: In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum suggest antibacterials are not needed. Discontinuation of empiric antibacterials should be considered after 48 hours in absence of sputum to culture or results reported "without growth" or "normal flora." Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance.Trial registration: Not applicable as this was a retrospective chart review study without interventional arm.

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“…4 , 5 This is becoming increasingly pertinent during the COVID-19 pandemic where antimicrobials are overused alongside a weakened antimicrobial stewardship program. 6 Data in such conflict affected countries is limited with little reliable data available for Syria. 7 The few published studies are limited by the small number of samples or patients, lack of generalizability, and mostly originated from the major cities, particularly Damascus and Aleppo.…”

mentioning

confidence: 99%

High rates of antimicrobial resistance among clinical isolates from microbiology laboratories in Syria

Karamya

Youssef

Adra

et al. 2021

Journal of Infection

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Improving antibiotic stewardship in COVID-19: Bacterial co-infection is less common than with influenza

Cited by 63 publications

References 4 publications

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

High rates of antimicrobial resistance among clinical isolates from microbiology laboratories in Syria

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