Mary Wilson
Well-known member
Published:November 26, 2021
DOI: https://doi.org/10.1016/j.cmi.2021.11.008
Bradley J. Langford, BScPhm, PharmD, Miranda So, BScPhm, PharmD, MPH, Valerie Leung, BScPhm, MBA, Sumit Raybardhan, BScPhm, MPH, Jennifer Lo, BScPhm, PharmD, Tiffany Kan, BScPhm, PharmD,
Felicia Leung, HBSc, Duncan Westwood, BA, Nick Daneman, MD, MSc, Derek R. MacFadden, MD, ScD,
Jean-Paul R. Soucy, MSc
Abstract
Objective
To identify risk factors and microbiology associated with respiratory and bloodstream bacterial infection in patients with COVID-19.
Methods
Data Sources: We searched MEDLINE, OVID Epub and EMBASE for published literature up to February 5, 2021. Study eligibility criteria:Studies including at least 50 patients with COVID-19 in any healthcare setting. Assessment of risk of Bias: We used a validated 10-item risk of bias tool for disease prevalence Methods of data synthesis: The main outcome of interest was the proportion of COVID-19 patients with bloodstream and/or respiratory bacterial co-infection and secondary infection. We performed meta-regression to identify study population factors associated with bacterial infection including healthcare setting, age, comorbidities and COVID-19 medication.
Results
Out of 33,345 studies screened, 171 were included in the final analysis. Bacterial infection data were available from 171,262 patients. The prevalence of co-infection was 5.1% (95% CI: 3.6% to 7.1%) and secondary infection was 13.1% (95% CI: 9.8% to 17.2%). There was a higher odds of bacterial infection in studies with a higher proportion of patients in the intensive care unit (ICU) (adjusted OR 18.8, 95% CI: 6.5 to 54.8). Female sex was associated with a lower odds of secondary infection (adjusted OR 0.73, 95% CI: 0.55 to 0.97) but not co-infection (adjusted OR 1.05, 95% CI: 0.80 to 1.37). The most common organisms isolated included Staphylococcus aureus, coagulase-negative Staphylococci, and Klebsiella species.
Conclusions
While the odds of respiratory and bloodstream bacterial infection are low in patients with COVID-19, meta-regression revealed potential risk factors for infection, including ICU setting and mechanical ventilation. The risk for secondary infection is substantially greater than the risk for co-infection in patients with COVID-19. Understanding predictors of co-infection and secondary infection may help to support improved antibiotic stewardship in patients with COVID-19.
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(21)00636-4/fulltext
DOI: https://doi.org/10.1016/j.cmi.2021.11.008
Bradley J. Langford, BScPhm, PharmD, Miranda So, BScPhm, PharmD, MPH, Valerie Leung, BScPhm, MBA, Sumit Raybardhan, BScPhm, MPH, Jennifer Lo, BScPhm, PharmD, Tiffany Kan, BScPhm, PharmD,
Felicia Leung, HBSc, Duncan Westwood, BA, Nick Daneman, MD, MSc, Derek R. MacFadden, MD, ScD,
Jean-Paul R. Soucy, MSc
Abstract
Objective
To identify risk factors and microbiology associated with respiratory and bloodstream bacterial infection in patients with COVID-19.
Methods
Data Sources: We searched MEDLINE, OVID Epub and EMBASE for published literature up to February 5, 2021. Study eligibility criteria:Studies including at least 50 patients with COVID-19 in any healthcare setting. Assessment of risk of Bias: We used a validated 10-item risk of bias tool for disease prevalence Methods of data synthesis: The main outcome of interest was the proportion of COVID-19 patients with bloodstream and/or respiratory bacterial co-infection and secondary infection. We performed meta-regression to identify study population factors associated with bacterial infection including healthcare setting, age, comorbidities and COVID-19 medication.
Results
Out of 33,345 studies screened, 171 were included in the final analysis. Bacterial infection data were available from 171,262 patients. The prevalence of co-infection was 5.1% (95% CI: 3.6% to 7.1%) and secondary infection was 13.1% (95% CI: 9.8% to 17.2%). There was a higher odds of bacterial infection in studies with a higher proportion of patients in the intensive care unit (ICU) (adjusted OR 18.8, 95% CI: 6.5 to 54.8). Female sex was associated with a lower odds of secondary infection (adjusted OR 0.73, 95% CI: 0.55 to 0.97) but not co-infection (adjusted OR 1.05, 95% CI: 0.80 to 1.37). The most common organisms isolated included Staphylococcus aureus, coagulase-negative Staphylococci, and Klebsiella species.
Conclusions
While the odds of respiratory and bloodstream bacterial infection are low in patients with COVID-19, meta-regression revealed potential risk factors for infection, including ICU setting and mechanical ventilation. The risk for secondary infection is substantially greater than the risk for co-infection in patients with COVID-19. Understanding predictors of co-infection and secondary infection may help to support improved antibiotic stewardship in patients with COVID-19.
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(21)00636-4/fulltext