Low frequency of community-acquired bacterial co-infection in patients hospitalized for COVID-19 based on clinical, radiological and microbiological criteria: a retrospective cohort study

Abstract

Background We defined the frequency of respiratory community-acquired bacterial co-infection in patients with COVID-19, i.e. patients with a positive SARS-CoV-2 PCR or a COVID-19 Reporting and Data System (CO-RADS) score ≥ 4, based on a complete clinical assessment, including prior antibiotic use, clinical characteristics, inflammatory markers, chest computed tomography (CT) results and microbiological test results. Methods Our retrospective study was conducted within a cohort of prospectively included patients admitted for COVID-19 in our tertiary medical centres between 1-3-2020 and 1-6-2020. A multidisciplinary study team developed a diagnostic protocol to retrospectively categorize patients as unlikely, possible or probable bacterial co-infection based on clinical, radiological and microbiological parameters in the first 72 h of admission. Within the three categories, we summarized patient characteristics and antibiotic consumption. Results Among 281 included COVID-19 patients, bacterial co-infection was classified as unlikely in 233 patients (82.9%), possible in 35 patients (12.4%) and probable in 3 patients (1.1%). Ten patients (3.6%) could not be classified due to inconclusive data. Within 72 h of hospital admission, 81% of the total study population and 78% of patients classified as unlikely bacterial co-infection received antibiotics. Conclusions COVID-19 patients are unlikely to have a respiratory community-acquired bacterial co-infection. This study underpins recommendations for restrictive use of antibacterial drugs in patients with COVID-19.

Bacterial Pneumonia and Respiratory Culture Utilization among Hospitalized Patients with and without COVID-19 in New York City

“…Looking specifically at respiratory bacterial co-infections, our study found 1.2% of COVID-19 patients with positive cultures in the first three days of hospitalization, in contrast to 6.3% of COVID-19 patients with abnormal cultures representing HAP or VAP by this definition. The low rate of community-acquired respiratory infections we found here further supports these authors’ conclusions that empiric antibiotic therapy for COVID-19 patients is generally not indicated during early hospitalization [10, 11]. Similarly, our finding that non-intubated patients had lower rates of bacterial pneumonia, when those rates were normalized by respiratory culture ordering, argues against routine respiratory culture and empiric pneumonia therapy in these patients.…”

“…We also found similarly low rates of CAP in COVID-19 patients compared to what has previously been cited in the literature. A recent study of hospitalized COVID-19 patients looking specifically at rates of bacterial co-infection within the first three days of hospitalization and finding 1.1% with probable infection, and additional 12.4% with possible co-infection, when all types of infection were considered [10]. Looking specifically at respiratory bacterial co-infections, our study found 1.2% of COVID-19 patients with positive cultures in the first three days of hospitalization, in contrast to 6.3% of COVID-19 patients with abnormal cultures representing HAP or VAP by this definition.…”

SARS-CoV-2–Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020–2021)

“…After applying the inclusion and exclusion criteria ( Figure 1 ), a total of 38 articles were included in the qualitative synthesis [ 23 , 24 , 26 , 28 , 29 , 35 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. More precisely, 27 observational studies (see Table 1 for details), 1 case series, and 10 case reports (see Appendix A for details) were included.…”

“…Overall, 18 cases of co-infections were retrieved (0.4% of total samples), with the majority of studies (18 out of 27, 66.7%) not reporting a single occurrence [ 23 , 24 , 26 , 42 , 44 , 46 , 48 , 50 , 53 , 54 , 55 , 56 , 58 , 59 , 61 , 63 ]. The majority of diagnoses was obtained from studies performed during the “first wave” (61.1%) and in European countries (50.0%).…”

“…The majority of the reports came from European countries (n = 17, 63.0%), followed by China (n = 4, 14.8%) and India (n = 2, 7.4%), while a single report was retrieved from Israel, Japan, Peru, and the USA, respectively (3.7% each). Overall, 18 cases of co-infections were retrieved (0.4% of total samples), with the majority of studies (18 out of 27, 66.7%) not reporting a single occurrence [23,24,26,42,44,46,48,50,[53][54][55][56]58,59,61,63]. The majority of diagnoses was obtained from studies performed during the "first wave" (61.1%) and in European countries (50.0%).…”