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Eur J Clin Microbiol Infect Dis
. 2020 Nov 2.
doi: 10.1007/s10096-020-04063-8. Online ahead of print.
Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship
Kathrin Rothe 1 , Susanne Feihl 2 , Jochen Schneider 3 , Fabian Walln?fer 3 , Milena Wurst 3 , Marina Lukas 3 , Matthias Treiber 3 , Tobias Lahmer 3 , Markus Heim 4 , Michael Dommasch 5 , Birgit Waschulzik 6 , Alexander Zink 7 , Christiane Querbach 8 , Dirk H Busch 2 9 , Roland M Schmid 3 , Gerhard Schneider 4 , Christoph D Spinner 3 9
Affiliations
- PMID: 33140176
- DOI: 10.1007/s10096-020-04063-8
Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17-99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1-13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.
Keywords: Antibiotic stewardship; Bacterial co-infections; COVID-19; Diagnostic stewardship.