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Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship.

Authors
  • Rothe, Kathrin1
  • Feihl, Susanne2
  • Schneider, Jochen3
  • Wallnöfer, Fabian3
  • Wurst, Milena3
  • Lukas, Marina3
  • Treiber, Matthias3
  • Lahmer, Tobias3
  • Heim, Markus4
  • Dommasch, Michael5
  • Waschulzik, Birgit6
  • Zink, Alexander7
  • Querbach, Christiane8
  • Busch, Dirk H2, 9
  • Schmid, Roland M3
  • Schneider, Gerhard4
  • Spinner, Christoph D3, 9
  • 1 Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Trogerstr. 30, 81675, Munich, Germany. [email protected] , (Germany)
  • 2 Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Trogerstr. 30, 81675, Munich, Germany. , (Germany)
  • 3 Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany. , (Germany)
  • 4 Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany. , (Germany)
  • 5 Department of Internal Medicine I, Technical University of Munich, School of Medicine, Munich, Germany. , (Germany)
  • 6 Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, School of Medicine, Munich, Germany. , (Germany)
  • 7 Department of Dermatology and Allergology, Technical University of Munich, School of Medicine, Munich, Germany. , (Germany)
  • 8 Hospital Pharmacy, Technical University of Munich, School of Medicine, Munich, Germany. , (Germany)
  • 9 German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany. , (Germany)
Type
Published Article
Journal
European Journal of Clinical Microbiology & Infectious Diseases
Publisher
Springer-Verlag
Publication Date
Nov 02, 2020
Identifiers
DOI: 10.1007/s10096-020-04063-8
PMID: 33140176
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17-99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1-13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.

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