tetano
Editor, Senior Moderator
Lancet Microbe
. 2021 Jun 2.
doi: 10.1016/S2666-5247(21)00090-2. Online ahead of print.
Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study
Clark D Russell[SUP] 1 2 [/SUP], Cameron J Fairfield[SUP] 3 [/SUP], Thomas M Drake[SUP] 3 [/SUP], Lance Turtle[SUP] 4 5 [/SUP], R Andrew Seaton[SUP] 6 [/SUP], Dan G Wootton[SUP] 4 5 [/SUP], Louise Sigfrid[SUP] 7 [/SUP], Ewen M Harrison[SUP] 3 [/SUP], Annemarie B Docherty[SUP] 3 [/SUP], Thushan I de Silva[SUP] 8 9 [/SUP], Conor Egan[SUP] 3 [/SUP], Riinu Pius[SUP] 3 [/SUP], Hayley E Hardwick[SUP] 4 [/SUP], Laura Merson[SUP] 7 [/SUP], Michelle Girvan[SUP] 10 [/SUP], Jake Dunning[SUP] 11 [/SUP], Jonathan S Nguyen-Van-Tam[SUP] 12 13 [/SUP], Peter J M Openshaw[SUP] 14 [/SUP], J Kenneth Baillie[SUP] 2 [/SUP], Malcolm G Semple[SUP] 4 15 [/SUP], Antonia Ho[SUP] 16 [/SUP], ISARIC4C investigators
Collaborators, Affiliations
Abstract
Background: Microbiological characterisation of co-infections and secondary infections in patients with COVID-19 is lacking, and antimicrobial use is high. We aimed to describe microbiologically confirmed co-infections and secondary infections, and antimicrobial use, in patients admitted to hospital with COVID-19.
Methods: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study is an ongoing, prospective cohort study recruiting inpatients from 260 hospitals in England, Scotland, and Wales, conducted by the ISARIC Coronavirus Clinical Characterisation Consortium. Patients with a confirmed or clinician-defined high likelihood of SARS-CoV-2 infection were eligible for inclusion in the ISARIC WHO CCP-UK study. For this specific study, we excluded patients with a recorded negative SARS-CoV-2 test result and those without a recorded outcome at 28 days after admission. Demographic, clinical, laboratory, therapeutic, and outcome data were collected using a prespecified case report form. Organisms considered clinically insignificant were excluded.
Findings: We analysed data from 48 902 patients admitted to hospital between Feb 6 and June 8, 2020. The median patient age was 74 years (IQR 59-84) and 20 786 (42·6%) of 48 765 patients were female. Microbiological investigations were recorded for 8649 (17·7%) of 48 902 patients, with clinically significant COVID-19-related respiratory or bloodstream culture results recorded for 1107 patients. 762 (70·6%) of 1080 infections were secondary, occurring more than 2 days after hospital admission. Staphylococcus aureus and Haemophilus influenzae were the most common pathogens causing respiratory co-infections (diagnosed ≤2 days after admission), with Enterobacteriaceae and S aureus most common in secondary respiratory infections. Bloodstream infections were most frequently caused by Escherichia coli and S aureus. Among patients with available data, 13 390 (37·0%) of 36 145 had received antimicrobials in the community for this illness episode before hospital admission and 39 258 (85·2%) of 46 061 patients with inpatient antimicrobial data received one or more antimicrobials at some point during their admission (highest for patients in critical care). We identified frequent use of broad-spectrum agents and use of carbapenems rather than carbapenem-sparing alternatives.
Interpretation: In patients admitted to hospital with COVID-19, microbiologically confirmed bacterial infections are rare, and more likely to be secondary infections. Gram-negative organisms and S aureus are the predominant pathogens. The frequency and nature of antimicrobial use are concerning, but tractable targets for stewardship interventions exist.
Funding: National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, UK Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and NIHR HPRU in Respiratory Infections at Imperial College London.
. 2021 Jun 2.
doi: 10.1016/S2666-5247(21)00090-2. Online ahead of print.
Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study
Clark D Russell[SUP] 1 2 [/SUP], Cameron J Fairfield[SUP] 3 [/SUP], Thomas M Drake[SUP] 3 [/SUP], Lance Turtle[SUP] 4 5 [/SUP], R Andrew Seaton[SUP] 6 [/SUP], Dan G Wootton[SUP] 4 5 [/SUP], Louise Sigfrid[SUP] 7 [/SUP], Ewen M Harrison[SUP] 3 [/SUP], Annemarie B Docherty[SUP] 3 [/SUP], Thushan I de Silva[SUP] 8 9 [/SUP], Conor Egan[SUP] 3 [/SUP], Riinu Pius[SUP] 3 [/SUP], Hayley E Hardwick[SUP] 4 [/SUP], Laura Merson[SUP] 7 [/SUP], Michelle Girvan[SUP] 10 [/SUP], Jake Dunning[SUP] 11 [/SUP], Jonathan S Nguyen-Van-Tam[SUP] 12 13 [/SUP], Peter J M Openshaw[SUP] 14 [/SUP], J Kenneth Baillie[SUP] 2 [/SUP], Malcolm G Semple[SUP] 4 15 [/SUP], Antonia Ho[SUP] 16 [/SUP], ISARIC4C investigators
Collaborators, Affiliations
- PMID: 34100002
- PMCID: PMC8172149
- DOI: 10.1016/S2666-5247(21)00090-2
Abstract
Background: Microbiological characterisation of co-infections and secondary infections in patients with COVID-19 is lacking, and antimicrobial use is high. We aimed to describe microbiologically confirmed co-infections and secondary infections, and antimicrobial use, in patients admitted to hospital with COVID-19.
Methods: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study is an ongoing, prospective cohort study recruiting inpatients from 260 hospitals in England, Scotland, and Wales, conducted by the ISARIC Coronavirus Clinical Characterisation Consortium. Patients with a confirmed or clinician-defined high likelihood of SARS-CoV-2 infection were eligible for inclusion in the ISARIC WHO CCP-UK study. For this specific study, we excluded patients with a recorded negative SARS-CoV-2 test result and those without a recorded outcome at 28 days after admission. Demographic, clinical, laboratory, therapeutic, and outcome data were collected using a prespecified case report form. Organisms considered clinically insignificant were excluded.
Findings: We analysed data from 48 902 patients admitted to hospital between Feb 6 and June 8, 2020. The median patient age was 74 years (IQR 59-84) and 20 786 (42·6%) of 48 765 patients were female. Microbiological investigations were recorded for 8649 (17·7%) of 48 902 patients, with clinically significant COVID-19-related respiratory or bloodstream culture results recorded for 1107 patients. 762 (70·6%) of 1080 infections were secondary, occurring more than 2 days after hospital admission. Staphylococcus aureus and Haemophilus influenzae were the most common pathogens causing respiratory co-infections (diagnosed ≤2 days after admission), with Enterobacteriaceae and S aureus most common in secondary respiratory infections. Bloodstream infections were most frequently caused by Escherichia coli and S aureus. Among patients with available data, 13 390 (37·0%) of 36 145 had received antimicrobials in the community for this illness episode before hospital admission and 39 258 (85·2%) of 46 061 patients with inpatient antimicrobial data received one or more antimicrobials at some point during their admission (highest for patients in critical care). We identified frequent use of broad-spectrum agents and use of carbapenems rather than carbapenem-sparing alternatives.
Interpretation: In patients admitted to hospital with COVID-19, microbiologically confirmed bacterial infections are rare, and more likely to be secondary infections. Gram-negative organisms and S aureus are the predominant pathogens. The frequency and nature of antimicrobial use are concerning, but tractable targets for stewardship interventions exist.
Funding: National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, UK Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and NIHR HPRU in Respiratory Infections at Imperial College London.