Prevalence of Co-infection at the Time of Hospital Admission in COVID-19 Patients, A Multicenter Study

Abstract

Background Bacterial infections may complicate viral pneumonias. Recent reports suggest that bacterial co-infection at time of presentation is uncommon in coronavirus disease 2019 (COVID-19); however, estimates were based on microbiology tests alone. We sought to develop and apply consensus definitions, incorporating clinical criteria to better understand the rate of co-infections and antibiotic use in COVID-19. Methods A total of 1016 adult patients admitted to 5 hospitals in the Johns Hopkins Health System between March 1, 2020, and May 31, 2020, with COVID-19 were evaluated. Adjudication of co-infection using definitions developed by a multidisciplinary team for this study was performed. Both respiratory and common nonrespiratory co-infections were assessed. The definition of bacterial community-acquired pneumonia (bCAP) included proven (clinical, laboratory, and radiographic criteria plus microbiologic diagnosis), probable (clinical, laboratory, and radiographic criteria without microbiologic diagnosis), and possible (not all clinical, laboratory, and radiographic criteria met) categories. Clinical characteristics and antimicrobial use were assessed in the context of the consensus definitions. Results Bacterial respiratory co-infections were infrequent (1.2%); 1 patient had proven bCAP, and 11 (1.1%) had probable bCAP. Two patients (0.2%) had viral respiratory co-infections. Although 69% of patients received antibiotics for pneumonia, the majority were stopped within 48 hours in patients with possible or no evidence of bCAP. The most common nonrespiratory infection was urinary tract infection (present in 3% of the cohort). Conclusions Using multidisciplinary consensus definitions, proven or probable bCAP was uncommon in adults hospitalized due to COVID-19, as were other nonrespiratory bacterial infections. Empiric antibiotic use was high, highlighting the need to enhance antibiotic stewardship in the treatment of viral pneumonias.

Coinfections in Patients Hospitalized with COVID-19: A Descriptive Study from the United Arab Emirates

“…This is in keeping with previously reported work that showed that bacterial coinfection was rarely documented in COVID-19 patients at admission and suggests that careful review of routine initiation of empirical antibiotics in COVID-19 patients is warranted. 22 Our findings indicate that Gram-negative pathogens maintained an overall predominance as causative agents of initial and subsequent infections. This finding of a predominance of Gram-negative bacteria is in keeping with a pattern reported in a systematic review of 30 studies reporting coinfections in 3,834 patients with COVID-19.…”

“…This finding of a predominance of Gram-negative bacteria is in keeping with a pattern reported in a systematic review of 30 studies reporting coinfections in 3,834 patients with COVID-19. 22 Although there was variability in antimicrobial resistance, the bacterial isolates showed a higher trend of antibiotic resistance than the fungal isolates, which had high sensitivity to the antifungal tested. Additionally, commonly used empirical antibiotics were infrequently tested or exhibited low susceptibility profiles.…”

Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-Positive and -Negative US Patients With a Positive Bacterial Culture: A Multicenter Evaluation From March to November 2020

“…The data in our study indicate that the high burden of care for hospitalized patients with COVID-19 is further exacerbated by IET in the presence of a non-SARS-CoV-2 pathogen, and that IET is common in hospitalized patients with positive bacterial cultures. Although the ability of IET to negatively impact outcomes is well known [ 9–11 ], our findings serve as a valuable reminder that the importance of AET is heightened during times when hospital resources are stretched thin. In addition, our data indicate that IET affects patients with positive bacterial cultures from a number of sources, not just those involving bloodstream infections, which are typically more severe.…”

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic

“…Concern for community-acquired pneumonia, nosocomial bacterial superinfection in longer hospitalized patients, and high mortality due to COVID-19 among risk groups such as age over 60 years and underlying medical conditions has made the HCP consider antibiotics as a treatment strategy [ 3 , 6 , 7 , 8 ]. Uses of antibiotics for treating COVID-19 patients were found up to 72% around the globe [ 5 , 6 , 7 , 8 , 9 ], whereas bacterial co-infection was only 1–16% among those patients who received antibiotics [ 9 , 10 , 11 , 12 , 13 ]. Broad-spectrum antibiotics were commonly used in order to cover a wide range of bacteria [ 4 , 6 , 7 , 8 , 9 ].…”