Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19

Abstract

SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being one of the most significant challenges of health care systems worldwide. Bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 (COVID-19) are uncommon but consumption of antibiotics and antifungals has increased dramatically during the ongoing pandemic resulting in increased selective pressure for global antimicrobial resistance. Nosocomial bacterial superinfections appear to be more frequent than community-acquired coinfections, particularly among patients admitted to the intensive care unit (ICU) and those receiving immunosuppressive treatment. Fungal infections associated with COVID-19 might be missed or misdiagnosed. Existing and new antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19 pandemic and are urgently needed to contain the high rates of misdiagnosis and antimicrobial prescription. The aim of this review is to describe the role of bacterial and fungal infections and possible strategies of AMS to use in daily practice for optimal management of COVID-19.

Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients

“…Infections pose a significant problem in ICUs [ 10 , 19 , 34 , 35 , 36 ], especially in patients with viral respiratory infections. In severe influenza, for example, bacterial co-infections have been described in up to 20% to 30% of cases, and superinfections have been associated with pronounced disease severity and a higher risk of death [ 17 , 26 , 28 , 29 , 34 , 35 , 36 ].…”

“…Infections pose a significant problem in ICUs [ 10 , 19 , 34 , 35 , 36 ], especially in patients with viral respiratory infections. In severe influenza, for example, bacterial co-infections have been described in up to 20% to 30% of cases, and superinfections have been associated with pronounced disease severity and a higher risk of death [ 17 , 26 , 28 , 29 , 34 , 35 , 36 ]. Consequently, in critically ill COVID-19 patients, the prevalence of bacterial and fungal co-infections, their impact on the clinical course, and appropriate antimicrobial therapy in a primarily viral disease are of particular importance.…”

“…Thus, for the group of COVID-19 patients with a critical course, it resulted that colonization at the time of diagnosis of SARS-CoV-2 infection was rare, especially with regard to the most clinically relevant multidrug-resistant pathogens. Indeed, other studies have also reported low rates of early infection and, rather, direct the focus to nosocomial infection [ 17 , 34 ]. Reported rates of secondary bacterial infections in critically ill ICU patients with COVID-19 have ranged from 8.1% to 42.8% [ 13 , 17 , 18 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

“…COVID-19 is responsible for a respiratory disease whose Several studies reported a huge discrepancy between empiric antimicrobial prescribing (72-100%) and the reported incidence of secondary infection (8-15%) [7,15]. Therefore, in the context of rising levels of antimicrobial resistance and approximately one-third of all the infectious episodes being due to multi-drug-resistant organisms (35%), understanding the proportion of COVID-19 patients with co-infection and secondary infection and the culprit pathogens is crucial for a correct treatment of these patients and to ensure responsible use of antibiotics [19].…”

“…In particular, the incidence of secondary pulmonary infections in hospitalized patients was reported to be 16% (4.8–42.8%) and 6.3% (0.9–33.3%) for bacterial and fungal infections, respectively [ 10 ]. In critically ill patients, the incidence of superinfections is much higher, reaching up to 45% of cases [ 15 , 16 , 17 , 18 ], and is constituted mostly of pneumonia (50%) and bloodstream infections (34%) [ 19 ].…”