Rates of coinfection with other respiratory pathogens in patients positive for coronavirus disease 2019 (COVID‐19)

Abstract

Objectives The purpose of this study was to assess coinfection rates of coronavirus disease 2019 (COVID‐19) with other respiratory infections on presentation. Methods This is a retrospective analysis of data from a 2 hospital academic medical centers and 2 urgent care centers during the initial 2 weeks of testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), March 10, 2020 to March 23, 2020. Testing was targeted toward high‐risk patients following US Centers for Disease Control and Prevention guidelines. Demographics include age group and sex. Laboratory test results included SARS‐CoV‐2, rapid influenza A/B, and upper respiratory pathogen nucleic acid detection. Patient demographics and coinfections are presented overall and by test results with descriptive statistics. Results Complete laboratory results from the first 2 weeks of testing were available for 471 emergency department patients and 117 urgent care center patients who were tested for SARS‐CoV. A total of 51 (8.7%) patients tested positive for COVID‐19 with only 1 of these patients also testing positive for another respiratory infection. One of the patients positive for COVID‐19 also tested positive for influenza A. Among the 537 patients who were screened and tested negative for COVID‐19, there were 33 (6.1%) patients who tested positive in the upper respiratory pathogen nucleic acid detection test. Conclusion In our study investigating coinfections among 51 patients testing positive for COVID‐19, 1 patient also tested positive for influenza A. Although we found limited coinfections in our emergency department and urgent care center patient populations, further research is needed to assess potential coinfection in patients with COVID‐19.

Reducing the use of empiric antibiotic therapy in patients on admission to the hospital with COVID-19

“…As every patient received an ID consultation, we were able to monitor this practice directly. Similar to previous reports [1][2][3][4] , we observed a high rate of antibiotic prescribing (49%, 246/505) among patients admitted with COVID-19 despite available data suggesting that bacterial co-infection is uncommon among patients with the disease. Our data similarly re ects low rates (4.5%) of co-infection with bacterial pathogens which further supports a need for stewardship interventions to reduce antimicrobial prescribing in this patient population.…”

“…However, the widespread prescribing of empiric antibiotics for possible bacterial pneumonia is not well supported by available literature regarding co-infections in the setting of COVID-19. [1][2][3][4][5] A recent review identi ed that despite a low incidence (8%) of reported co-infections among patients with COVID-19, 72% of patients receive antimicrobial therapy. 1 Though initiating empiric antibiotics for CABP may be reasonable, antibiotic therapy should be re-evaluated once COVID-19 pneumonia is con rmed.…”

Broad respiratory testing to identify SARS-CoV-2 viral co-circulation and inform diagnostic stewardship in the COVID-19 pandemic

“…maintained broad, syndromic nucleic acid testing for additional viral and bacterial pathogens, rapidly amassing data on 18 respiratory pathogens from 52,285 respiratory specimens, including SARS-CoV-2. As a result, to our knowledge this study represents the largest single-year eCoV study(2)(3)(4)(5) and by far the largest eCoV study during the COVID-19 pandemic(7)(8)(9)(10)(11)(12)(13). This broad testing approach helps to address a pivotal diagnostic gap amidst the emergence of a novel pathogen: co-infection and possible cross-reactivity with other pathogens that can cause similar clinical presentations.…”

“…Since SARS-CoV-2 emerged, there has been little research on the concurrent circulation of these other respiratory viruses, which had been the subject of broad surveillance in the years prior (2)(3)(4)(5): only a handful of case reports have described coinfections between SARS-CoV-2 and other respiratory viruses able to cause similar symptoms (6)(7)(8)(9)(10)(11)(12)(13). With unprecedented demand on clinical diagnostics, re-prioritized surveillance is one of many ways that laboratories have had to prioritize and adapt throughout this pandemic (14)(15)(16)(17).…”

The chronicles of COVID

“…This brief commentary is intended to accompany the journal's podcast on several articles. [1][2][3][4][5][6][7][8][9] The 2019 novel coronavirus (COVID-19) has occupied most of our personal and professional lives this year. This August edition of the journal has 9 contributions about the pandemic and our colleagues' Collectively, the 9 articles in the August edition of JACEP Open provide a broad description of both the COVID epidemiology and the health care response.…”