Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes

Abelenda-Alonso, Gabriela; Rombauts, Alexander; Gudiol, Carlota; Meije, Yolanda; Ortega, Lucía; Clemente, Mercedes; Ardanuy, Carmen; Niubó, Jordi; Carratalà, Jordi

doi:10.1093/ofid/ofaa066

Cited by 34 publications

(23 citation statements)

References 39 publications

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“…Bacterial community-acquired pneumonia co-infections documented in our cohort have been especially low. Considering the high number and severity of bacterial co-infections previously reported in patients with influenza H1N1 and H3N2 [ [6] , [7] , [8] , [9] ], at the arrival of the COVID-19 pandemic, our hospital protocol recommended the initiation of antibiotic therapy for all hospitalized patients with COVID-19. Experience acquired within the first few weeks led us to reconsider this approach so as to administer empiric antibiotic therapy solely to patients who were admitted for COVID-19 and who presented with a chest X-ray suggestive of bacterial infection, need for direct ICU admission or severe immunocompromised condition.…”

Section: Discussionmentioning

confidence: 99%

“…One such clinical decision regards the delivery of antibiotic therapy to patients with COVID-19. Bacterial, especially Streptococcus pneumoniae and Staphylococcus aureus , and viral or fungal co-infections are common complications described as arising in other pandemics caused by influenza viruses [ [6] , [7] , [8] , [9] ]. However, information concerning incidence of such co-infections in patients with COVID-19 has been scarce.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

García-Vidal

Sanjuan

Moreno-García

et al. 2021

Clinical Microbiology and Infection

708

772

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Objectives To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records. Results Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus . A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli , were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes. Conclusions Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

García-Vidal

Sanjuan

Moreno-García

et al. 2021

Clinical Microbiology and Infection

708

772

View full text Add to dashboard Cite

show abstract

“…It is known that bacteria (especially Streptococcus pneumoniae and Staphylococcus aureus) as well as other viral or fungal co-infections are frequent complications that occur in seasonal influenza outbreaks which contribute to increased morbidity and mortality in these patients [38][39][40]. Previous studies have documented that fatality associated with viral pneumonias may be influenced by multiple factors, one of the most prominent being bacterial co-infection [41,42].…”

Section: What Causes the Indiscriminate Use Of Empiric Antibiotic Thementioning

confidence: 99%

Inadequate Use of Antibiotics in the Covid-19 Era: Effectiveness of Antibiotic Therapy

Estrada

Parra

Carracedo

et al. 2021

Preprint

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Background: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. Methods: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. Results: Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95%CI 1.21-1.62; p<.001) except macrolides, which had a higher survival rate (OR 0.70, 95%CI 0.64-0.76; p<.001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. Conclusions: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.

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“…Respiratory viral infections, especially in uenza, are associated with bacterial and fungal superinfection [8][9][10]. This has also been noted in previous coronavirus outbreaks of Severe Acute Respiratory Syndrome (SARS) [11] and Middle Eastern Respiratory Syndrome (MERS) [12].…”

Section: Introductionmentioning

confidence: 68%

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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Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes

Cited by 34 publications

References 39 publications

Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

Inadequate Use of Antibiotics in the Covid-19 Era: Effectiveness of Antibiotic Therapy

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

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