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Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
Jiyoung Lee1, Euijin Chang1, Jiwon Jung1
1Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Bacterial co-infections in COVID-19 patients were infrequent, with organism types varying based on prior antibiotic use. Empiric antibacterial treatment did not significantly impact mortality, suggesting a need for antibiotic stewardship in COVID-19 care.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Bacterial co-infection in coronavirus disease 2019 (COVID-19) patients requires evaluation, particularly concerning microbiological testing and empirical antibacterial use.
- The study addresses the rate and composition of bacterial co-infections in COVID-19 patients and their association with mortality.
Purpose of the Study:
- To evaluate the incidence and characteristics of bacterial co-infections in hospitalized COVID-19 patients.
- To determine the association between empirical antibacterial use and mortality in this patient cohort.
Main Methods:
- Retrospective study of adult COVID-19 patients hospitalized between February 2020 and December 2021 in South Korea.
- Bacterial co-infection assessed via sputum cultures, blood cultures, and molecular tests (PCR, urinary antigen tests).
- Comparison of mortality rates between patients receiving and not receiving empirical antibacterials, including propensity score matching.
Main Results:
- Out of 300 analyzed patients, 8.3% had bacterial co-infection within 48 hours.
- Co-infection rates were higher in patients with prior antibiotic exposure (11%) compared to those without (6.4%).
- Multi-drug resistant pathogens were found exclusively in the prior antibacterial-exposed group; empirical antibacterial therapy showed no significant association with mortality.
Conclusions:
- Bacterial co-infection is infrequent in COVID-19 patients undergoing microbiological testing.
- Co-infected organisms differ based on prior antibacterial exposure, with resistant pathogens noted in exposed individuals.
- Empiric antibacterial use in COVID-19 warrants careful consideration within antibiotic stewardship programs due to rarity of co-infection and lack of demonstrated benefit.
Background:
The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality.
Methods:
In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not.
Results:
Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching.
Conclusion:
In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.
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