An observational cohort study of bacterial co-infection and implications for empirical antibiotic therapy in patients presenting with COVID-19 to hospitals in North West London

Wang, Liyang; Amin, Anjali; Khanna, Priya; Aali, A Abdi; McGregor, Alastair; Bassett, Paul; Rao, G. Gopal

doi:10.1093/jac/dkaa475

Cited by 89 publications

(121 citation statements)

References 18 publications

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“…The severe form of COVID-19 infection appears preferentially beyond the seventh day after the onset of symptoms [1,2,4]. Bacterial co-infection (including pneumonia secondary to COVID-19 infection) is infrequent in hospitalized patients with COVID-19 infection, as observed by Wang et al [35]. They concerned less than 3% of patients in their retrospective observational cohort study of 1396 patients with COVID-19 infection.…”

Section: Discussionmentioning

confidence: 89%

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Dramé

Cofais²,

Hentzien

et al. 2021

Nutrients

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Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

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Section: Discussionmentioning

confidence: 89%

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Dramé

Cofais²,

Hentzien

et al. 2021

Nutrients

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“…Unlike previous studies [ 23 , 26 , 27 ], we did not restrict our analysis to the first 48 h of hospital admission and did not include infections other than BSI as secondary infections (also named superinfections) in COVID-19 patients. We specifically focused on BSI because this infection with its clinical consequences (i.e., sepsis or septic shock) [ 28 ] remains a major cause of mortality among hospitalized patients [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

Posteraro

Angelis

Menchinelli

et al. 2021

JCM

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The aim of this study was to characterize COVID-19 (SARS-CoV-2-infected) patients who develop bloodstream infection (BSI) and to assess risk factors associated with in-hospital mortality. We conducted a retrospective observational study of adult patients admitted for ≥48 h to a large Central Italy hospital for COVID-19 (1 March to 31 May 2020) who had or had not survived at discharge. We included only patients having blood cultures drawn or other inclusion criteria satisfied. Kaplan–Meier survival or Cox regression analyses were performed of 293 COVID-19 patients studied, 46 patients (15.7%) had a hospital-acquired clinically relevant BSI secondary to SARS-CoV-2 infection, accounting for 58 episodes (49 monomicrobial and 9 polymicrobial) in total. Twelve episodes (20.7%) occurred at day 3 of hospital admission. Sixty-nine species were isolated, including Staphylococcus aureus (32.8%), Enterobacterales (20.7%), Enterococcus faecalis (17.2%), Candida (13.8%) and Pseudomonas aeruginosa (10.3%). Of 69 isolates, 27 (39.1%) were multidrug-resistant organisms. Twelve (54.5%) of 22 patients for whom empirical antimicrobial therapy was inappropriate were infected by a multidrug-resistant organism. Of 46 patients, 26 (56.5%) survived and 20 (43.5%) died. Exploring variables for association with in-hospital mortality identified > 75-year age (HR 2.97, 95% CI 1.15–7.68, p = 0.02), septic shock (HR 6.55, 95% CI 2.36–18.23, p < 0.001) and BSI onset ≤ 3 days (HR 4.68, 95% CI 1.40–15.63, p = 0.01) as risk factors independently associated with death. In our hospital, mortality among COVID-19 patients with BSI was high. While continued vigilance against these infections is essential, identification of risk factors for mortality may help to reduce fatal outcomes in patients with COVID-19.

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“…It is important to note that bacterial co-infections are less prevalent than secondary infections. In a study of nearly 1,400 COVID-19 patients, only 2.7% were diagnosed with a bacterial infection that cooccurred with the viral infection (Wang et al, 2021). In another study, 5.1% of the cases (5 out of 99) with COVID-19 were reported to have co-infections including Acinetobacter baumannii and Klebsiella pneumoniae (Chen et al, 2020).…”

Section: Antibiotic Therapeutic Resistancementioning

confidence: 99%

The silent pandemic: Emergent antibiotic resistances following the global response to SARS-CoV-2

et al. 2021

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The ongoing SARS-CoV-2 pandemic has highlighted the importance of the rapid development of vaccines and antivirals. However, the potential for the emergence of antibiotic resistances due to the increased use of antibacterial cleaning products and therapeutics presents an additional, underreported threat. Most antibacterial cleaners contain simple quaternary ammonium compounds (QACs), however these compounds are steadily becoming less effective as antibacterial agents. QACs are extensively used in SARS-CoV-2 related sanitization in clinical and household settings. Similarly, due to the danger of secondary infections, antibiotic therapeutics are increasingly used as a component of COVID-19 treatment regimens, even in the absence of a bacterial infection diagnosis. The increased use of antibacterial agents as cleaners and therapeutics is anticipated to lead to novel resistances in the coming years.

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An observational cohort study of bacterial co-infection and implications for empirical antibiotic therapy in patients presenting with COVID-19 to hospitals in North West London

Cited by 89 publications

References 18 publications

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

The silent pandemic: Emergent antibiotic resistances following the global response to SARS-CoV-2

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