Predictors of respiratory bacterial co-infection in hospitalized COVID-19 patients

Bolker, Austin; Coe, Kelci E; Smith, Jessica M.; Stevenson, Kurt B.; Wang, Shuhua; Reed, Erica E

doi:10.1016/j.diagmicrobio.2021.115558

Cited by 16 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 148 included studies were published between December, 2019, and May, 2021. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 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 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , ...…”

Section: Resultsmentioning

confidence: 99%

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

Langford¹,

So²,

Simeonova³

et al. 2023

The Lancet Microbe

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 99%

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

Langford¹,

So²,

Simeonova³

et al. 2023

The Lancet Microbe

View full text Add to dashboard Cite

“…There are few studies evaluating whether acute phase reactants are useful as predictors of coinfection in patients with COVID-19. Bolker et al [ 22 ] found that the risk factors for respiratory bacterial coinfection upon hospital admission were nursing home stay, severe COVID-19, and leukocytosis; the other inflammatory markers within 72 h of admission (procalcitonin, CRP, IL-6, and ferritin) were not predictors. Mason et al [ 23 ], in a retrospective cohort study of patients with community-acquired pneumonia and patients with COVID-19, proposed that in COVID-19, the absence of both leukocytosis and an antibiotic-related decrease in C-reactive protein can exclude bacterial coinfection.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic concordance between BioFire® FilmArray® Pneumonia Panel and culture in patients with COVID-19 pneumonia admitted to intensive care units: the experience of the third wave in eight hospitals in Colombia

et al. 2022

View full text Add to dashboard Cite

Background The detection of coinfections is important to initiate appropriate antimicrobial therapy. Molecular diagnostic testing identifies pathogens at a greater rate than conventional microbiology. We assessed both bacterial coinfections identified via culture or the BioFire® FilmArray® Pneumonia Panel (FA-PNEU) in patients infected with SARS-CoV-2 in the ICU and the concordance between these techniques. Methods This was a prospective study of patients with SARS-CoV-2 who were hospitalized for no more than 48 h and on mechanical ventilation for no longer than 24 h in 8 ICUs in Medellín, Colombia. We studied mini-bronchoalveolar lavage or endotracheal aspirate samples processed via conventional culture and the FA-PNEU. Coinfection was defined as the identification of a respiratory pathogen using the FA-PNEU or cultures. Serum samples of leukocytes, C-reactive protein, and procalcitonin were taken on the first day of intubation. We analyzed the empirical antibiotics and the changes in antibiotic management according to the results of the FA-PNEUM and cultures. Results Of 110 patients whose samples underwent both methods, FA-PNEU- and culture-positive samples comprised 24.54% versus 17.27%, respectively. Eighteen samples were positive in both techniques, 82 were negative, 1 was culture-positive with a negative FA-PNEU result, and 9 were FA-PNEU-positive with negative culture. The two bacteria most frequently detected by the FA-PNEU were Staphylococcus aureus (37.5%) and Streptococcus agalactiae (20%), and those detected by culture were Staphylococcus aureus (34.78%) and Klebsiella pneumoniae (26.08%). The overall concordance was 90.1%, and when stratified by microorganism, it was between 92.7 and 100%. The positive predictive value (PPV) was between 50 and 100% and were lower for Enterobacter cloacae and Staphylococcus aureus. The negative predictive value (NPV) was high (between 99.1 and 100%); MecA/C/MREJ had a specificity of 94.55% and an NPV of 100%. The inflammatory response tests showed no significant differences between patients whose samples were positive and negative for both techniques. Sixty-one patients (55.45%) received at least one dose of empirical antibiotics. Conclusions The overall concordance was 90.1%, and it was between 92.7% and 100% when stratified by microorganisms. The positive predictive value was between 50 and 100%, with a very high NPV.

show abstract

“…A cohort study showed a 3.2% rate of bacterial co-infections on admission and 6.1% during hospitalization [16]. In a different cohort study, a respiratory bacterial co-infection rate of 11.2% was identified [17]. A systematic review described a bacterial co-infection rate of 8%; however, 72% of patients received empirical antibiotic treatment [18].…”

Section: Discussionmentioning

confidence: 99%

Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward

2023

View full text Add to dashboard Cite

Background: although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. Methods: in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. Results: from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54–76) vs. 65 (52.5–71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2–5) vs. 2 (1–4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p < 0.001, df = 3, X2 = 39.563] and required more oxygen [3 (0–6) vs. 0 (0–2), p < 0.001, r = 0.328]. Conclusion: empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment.

show abstract

Predictors of respiratory bacterial co-infection in hospitalized COVID-19 patients

Cited by 16 publications

References 11 publications

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

Diagnostic concordance between BioFire® FilmArray® Pneumonia Panel and culture in patients with COVID-19 pneumonia admitted to intensive care units: the experience of the third wave in eight hospitals in Colombia

Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward

Contact Info

Product

Resources

About