Bacterial and fungal coinfections in COVID-19 patients hospitalized during the New York City pandemic surge

Nori, Priya; Cowman, Kelsie; Chen, Victor; Bartash, Rachel; Szymczak, Wendy; Madaline, Theresa; Katiyar, Chitra Punjabi; Jain, Ruchika; Aldrich, Margaret; Weston, Gregory; Gialanella, Philip; Corpuz, Marilou; Gendlina, Inessa; Guo, Yi

doi:10.1017/ice.2020.368

Cited by 237 publications

(271 citation statements)

References 8 publications

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“…The COVID-19 cluster showed antibiotic use that was 2-3-fold higher than overall consumption. Nori et al 4 found widespread antibiotic use in most hospitalized COVID-19 patients, similar to our study. Difficulty in differentiating COVID-19 from other infections may explain empirical treatment, but it does not justify maintenance on antibiotics after SARS-CoV-2 identification.…”

Section: Discussionsupporting

confidence: 92%

Impact of the pandemic on antimicrobial consumption patterns

Silva

Deutschendorf

Nagel

et al. 2020

Infect. Control Hosp. Epidemiol.

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To the Editor-Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacts on economic, social, and healthcare systems. Uncertainties regarding coronavirus disease (COVID-19) promote concerns in choosing the best therapeutic strategy. Several drugs with antiviral effects were prescribed to treat COVID-19, but scientific evidence is not conclusive regarding benefit. Unnecessary antimicrobial use may cause an increase in multidrug-resistant organisms. 1,2 It is necessary to consider actions to prevent consequences that SARS-CoV-2 may have on antimicrobial use. 1,2 Antibiotic stewardship is a strategy to promote the optimal use of antibiotics. SARS-CoV-2 probably changes the antibiotic consumption profile, and it is necessary to measure this difference. Thus, our goal was to evaluate the impact of the pandemic on antimicrobial usage patterns comparing cohorts of SARS-CoV-2-positive and SARS-CoV-2-negative patients admitted in specific hospital locations.

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Section: Discussionsupporting

confidence: 92%

Impact of the pandemic on antimicrobial consumption patterns

Silva

Deutschendorf

Nagel

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…The higher rate of antimicrobial use may be due to initiation of empiric therapy for suspected pneumonia or sepsis, consistent with guidelines for the latter [ 30 ]. Other studies have also observed higher utilization of antibiotics in patients with SARS-CoV-2 with no identified coinfection [ 4 , 31 , 32 ]. Although most drug classes were used at comparable levels in the different groups, the use of macrolides was much higher in SARS-CoV-2-positive patients.…”

Section: Discussionmentioning

confidence: 94%

A multicenter analysis of the clinical microbiology and antimicrobial usage in hospitalized patients in the US with or without COVID-19

Puzniak

Finelli

et al. 2021

BMC Infect Dis

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Background Past respiratory viral epidemics suggest that bacterial infections impact clinical outcomes. There is minimal information on potential co-pathogens in patients with coronavirus disease-2019 (COVID-19) in the US. We analyzed pathogens, antimicrobial use, and healthcare utilization in hospitalized US patients with and without severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Methods This multicenter retrospective study included patients with > 1 day of inpatient admission and discharge/death between March 1 and May 31, 2020 at 241 US acute care hospitals in the BD Insights Research Database. We assessed microbiological testing data, antimicrobial utilization in admitted patients with ≥24 h of antimicrobial therapy, and length of stay (LOS). Results A total of 141,621 patients were tested for SARS-CoV-2 (17,003 [12.0%] positive) and 449,339 patients were not tested. Most (> 90%) patients tested for SARS-CoV-2 had additional microbiologic testing performed compared with 41.9% of SARS-CoV-2-untested patients. Non-SARS-CoV-2 pathogen rates were 20.9% for SARS-CoV-2-positive patients compared with 21.3 and 27.9% for SARS-CoV-2-negative and −untested patients, respectively. Gram-negative bacteria were the most common pathogens (45.5, 44.1, and 43.5% for SARS-CoV-2-positive, −negative, and −untested patients). SARS-CoV-2-positive patients had higher rates of hospital-onset (versus admission-onset) non-SARS-CoV-2 pathogens compared with SARS-CoV-2-negative or −untested patients (42.4, 22.2, and 19.5%, respectively), more antimicrobial usage (68.0, 45.2, and 25.1% of patients), and longer hospital LOS (mean [standard deviation (SD)] of 8.6 [11.4], 5.1 [8.9], and 4.2 [8.0] days) and intensive care unit (ICU) LOS (mean [SD] of 7.8 [8.5], 3.6 [6.2], and 3.6 [5.9] days). For all groups, the presence of a non-SARS-CoV-2 pathogen was associated with increased hospital LOS (mean [SD] days for patients with versus without a non-SARS-CoV-2 pathogen: 13.7 [15.7] vs 7.3 [9.6] days for SARS-CoV-2-positive patients, 8.2 [11.5] vs 4.3 [7.9] days for SARS-CoV-2-negative patients, and 7.1 [11.0] vs 3.9 [7.4] days for SARS-CoV-2-untested patients). Conclusions Despite similar rates of non-SARS-CoV-2 pathogens in SARS-CoV-2-positive, −negative, and −untested patients, SARS-CoV-2 was associated with higher rates of hospital-onset infections, greater antimicrobial usage, and extended hospital and ICU LOS. This finding highlights the heavy burden of the COVID-19 pandemic on healthcare systems and suggests possible opportunities for diagnostic and antimicrobial stewardship.

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“…1 Another single-center study from Spain showed increased use of amoxicillin-clavulanate during the early phase of the pandemic, followed by later increased utilization of broad-spectrum antibiotics. 2 There are several potential explanations for the observed increases in antimicrobial use including concerns of bacterial co-infection in suspected or newly diagnosed COVID-19 patients, increased risk of nosocomial infection due to administration of immunomodulatory therapy, reluctance to obtain diagnostic respiratory specimens, 3 diversion of clinical resources from stewardship activities during a time of crisis, and an increased proportion of hospitalizations being due to respiratory infections which typically prompt antibiotic therapy. Our finding that increases in antibiotic use were generalized across the VA and not restricted to facilities in areas with the highest case burden of COVID-19 suggests that issues not directly related to the care of COVID-19 patients contribute to the increased density of antibiotic use.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of increased antibiotic use during the COVID-19 pandemic have generally been from heavily impacted facilities or geographic regions and provide few details regarding patterns of antibiotic use. [1][2][3] To provide a broader overview of changes in antibiotic use in a healthcare system with a long-standing enterprise-wide commitment to antibiotic stewardship, we compared patterns of antibiotic use throughout the VA from January-May 2020 with corresponding time periods in prior years.…”

Section: Introductionmentioning

confidence: 99%