Co-infection with respiratory pathogens among COVID-2019 cases

Zhu, Xiaojuan; Ge, Yiyue; Wu, Tao; Zhao, Kun; Yin, Chen; Wu, Bin; Zhu, Fengcai; Zhu, Baoli; Cui, Lunbiao

doi:10.1016/j.virusres.2020.198005

Cited by 520 publications

(629 citation statements)

References 9 publications

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“…Our patients were sicker than in a study of hospitalised but not intubated patients and there was longer patient follow up [22]. Microorganisms recovered in our study were similar in some regards to published data [22] but with relatively few Streptococcus pneumoniae, Haemophilus, and Moraxella isolates compared with a Chinese study [25]. Testing was not done for Mycoplasma pneumoniae which was a common superinfecting pathogen in one review [26].…”

Section: Discussionsupporting

confidence: 74%

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Liu

Yaron

Piraino

et al. 2020

Preprint

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Background: Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. Methods: Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1,058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05.Results: Average patient age was 68.7 years. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall were evaluated and did not suggest acute bacterial or fungal infection in 89 (54%) of 165 individuals sampled within 24 hours of intubation. Cultures > one week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus.Conclusions: In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum suggest antibacterials are not needed. Discontinuation of empiric antibacterials should be considered after 48 hours in absence of sputum to culture or results reported "without growth" or "normal flora." Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance.Trial registration: Not applicable as this was a retrospective chart review study without interventional arm.

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Section: Discussionsupporting

confidence: 74%

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Liu

Yaron

Piraino

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In ammatory storms have been mentioned in many studies, and our study also con rmed the in ammatory response [24] . This study indicated that male patients had higher levels of in ammatory markers (including CRP, SAA, FIB), suggesting that bacterial infection is more common in male patients and might aggravate the disease progression [25,26] . The elevated AST and CK levels suggested that it may be related to the tissue damage mediated by virus, and the male response is more severe than female.…”

Section: Discussionmentioning

confidence: 74%

Sex Differences in Clinical Characteristics and Risk Factors for Disease Severity of Hospitalized Patients with COVID-19 in Beijing

Wang

Cao

et al. 2020

Preprint

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Background: Recent studies reported that sex differences in patients with coronavirus disease-2019 (COVID-19). However the predictive value of sex differences in disease severity were less studied by previous scholars. Methods: All adults (≥18 years) diagnosed with COVID-19 and admitted to Beijing Ditan Hospital, Capital Medical University (admission date from January 13 to March 19, 2020) were included in samples. Data analyzed in this study included epidemiological, demographic, comorbidities, initial symptoms and signs, laboratory findings, imaging study, disease severity and in-hospital mortality. Results: A total of 185 inpatients were enrolled in the study, among whom 95 patients are males (51.4%). The mean age of all patients was 41 years. Based on the hospital record, the duration from symptoms initiation to hospital admission was longer for men than that for women. Moreover, the mean BMI of males was relatively higher compared to females (25.45vs22.29, p<.001). In addition, the proportion of male patients with CHD, NAFLD, smoking and drinking history was higher than females. During the hospital stay, compared to female patients, male patients were more prone to develop symptoms such as high fever, cough, and chill. Higher levels of AST, CK, CRP and FIB were also observed in male patients. Following this fact, more patients with abnormal CT activities, severe and critical symptoms were developed in male group than females. However, there was no difference in complications and outcome between two groups. By analyzing data comprehensively, we found out that age (analyzed in quartiles, OR: 1.087; 95% CI: 1.038–1.139; p <.001) and BMI (OR: 1.250; 95% CI: 1.046–1.493; p =.014) could be used to help predict disease severity. Conclusions: In this cohort of hospitalized patients in Beijing, male patients developed more clinical symptoms, obtained more abnormal laboratory test results, and showed higher rates in severity of COVID-19. Other than that, the severity of COVID-19 was positively correlated with age and BMI independently.

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“…Similar results were published recently [1 -4], showing in general low rates of bacterial and fungal co-infections and a widespread antibiotic use in patients with con rmed COVID-19. In one study only, a high incidence of bacterial and fungal coinfections was presented [5].…”

Section: Discussionmentioning

confidence: 95%

Bacterial and fungal co-infections, antimicrobial treatment and clinical outcome in COVID-19 patients in an acute Irish hospital

Omar

Williams

Finn

et al. 2020

Preprint

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Background Serious bacterial infections may be missed when all attention focuses on COVID-19. It is therefore important to consider bacterial infection when assessing the febrile patient.Aims The aim of the study was to look at the bacterial and fungal co-infections, antimicrobial treatment and clinical outcome in COVID-19 patients in an acute Irish hospital.Methods A retrospective study of all laboratory confirmed COVID-19 cases admitted to a secondary care university hospital was performed, and clinical, radiology and laboratory data was extracted and analysed.Results 42 patients met eligibility criteria for the study inclusion. Male/female ratio was 22/20 (52.4%/47.6%), median age of the patients was 64 years and the median duration of hospital stay was 11 day. In-hospital mortality rate was 3 (7.1%). Four laboratory confirmed co-infections were identified in 3 (7.1%) patients. All 3 patients were discharged home. Out of 42 patients, 12 (28.6%) patients received specific antiviral treatment. 34 (85.0%) patients were prescribed antimicrobials with antibacterial effect and 3 (7.5%) antimicrobials with antifungal effect.Conclusions We found a low frequency of bacterial and fungal co-infections in confirmed COVID-19 cases. Further prospective data are needed to be collected in relation to the co-infections in COVID-19.

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Co-infection with respiratory pathogens among COVID-2019 cases

Cited by 520 publications

References 9 publications

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Sex Differences in Clinical Characteristics and Risk Factors for Disease Severity of Hospitalized Patients with COVID-19 in Beijing

Bacterial and fungal co-infections, antimicrobial treatment and clinical outcome in COVID-19 patients in an acute Irish hospital

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