Bacterial co-infection uncommon in patients with community-acquired COVID-19: Lancet

‘Antimicrobial stewardship’ in COVID-19 patients will help slow emergence of antimicrobial resistance, report says

By DTE Staff
Published: Thursday 03 June 2021

Pills. Photo: Katy Warner via WikimediaBacterial co-infection is uncommon in patients with community-acquired novel coronavirus disease (COVID-19), according to a new analysis published in The Lancet Microbe journal June 2, 2021. This means if a COVID-19 infection is community-acquired, there is very less chance of an additional bacterial infection. 

There was, thus, a need to include guidance on the optimal usage of anti-microbial medicines while treating patients with COVID-19, according to the report.

Adopting measures to support optimal antimicrobial use, known as ‘antimicrobial stewardship’, in COVID-19 patients will help to slow the emergence of antimicrobial resistance, the research suggested, according to a press statement.

The authors said particular emphasis was to be placed on restricting empirical antimicrobial prescribing — when a medicine is administered before tests confirm a bacterial infection — especially when patients were first admitted to hospital.

Antonia Ho of the MRC-University of Glasgow Centre for Virus Research, UK, said in a press statement by The Lancet:

We now know that bacterial co-infection is uncommon in patients with community-acquired COVID-19. Since antimicrobial resistance remains one of the biggest public health challenges of our time, measures to combat it are essential to help ensure that these life-saving medicines remain an effective treatment for infection in years to come.

A previous systematic review and meta-analysis of 38 studies had suggested that bacterial respiratory and bloodstream infections were rare among patients hospitalised with COVID-19.

But the studies included were small and provided limited information on the timing of infection, specific bacteria causing the infections and antimicrobial drug classes used.

New study

The authors of the new study reported the numbers of COVID-19-related bacterial infections, types of bacteria identified, the number of people prescribed antimicrobials and the types of antimicrobials prescribed among 48,902 patients admitted to 260 hospitals in England, Scotland, and Wales due to COVID-19 between February 6 and June 8, 2020.

The timing of infection was recorded either as occurring prior to hospital admission (co-infection) or acquired after admission (secondary infection). The average patient age was 74 years, and 43 per cent (20,786 of 48,765 patients) were female.

Microbiological tests — including blood tests and analysis of sputum and deep lung samples — were recorded for 8,649 patients, with COVID-19-related respiratory or bloodstream bacterial infections detected in 1,107 patients.

When bacterial infections were detected in COVID-19 patients, 71 per cent (762 of 1,080) were secondary infections, acquired more than two days after patients were admitted to hospital.

Staphylococcus aureus and Haemophilus influenzae were the most common causes of respiratory co-infections, while Enterobacteriaceae and S aureus were the most common in secondary respiratory infections. Bloodstream infections were most often caused by Escherichia coli and S aureus.

Among patients with available data, 37 per cent (13,390 of 36,145 patients) had been prescribed antimicrobials for their illness by a doctor or pharmacist before being admitted to hospital.

Some 85 per cent (39,258 of 46,061 patients) received one or more antimicrobials at some point during their hospital stay. Antimicrobial use was highest during March and April 2020, but fell during May, so further assessment of any changes to patterns of prescribing was essential, the statement said.

Broad-spectrum agents such as carbapenems — a class of antimicrobials reserved for the treatment of severe or high-risk bacterial infections — were used frequently, accounting for 3.8 per cent of all prescriptions.

In contrast, carbapenem-sparing alternatives were used less often, accounting for between 0.2 per cent and 1.5 per cent of all prescriptions.

The authors recommend a range of existing antimicrobial stewardship interventions that should be prioritised for incorporation into COVID-19 patient care.

Besides restricting prescribing without a confirmed diagnosis, these included tailoring the choice of antimicrobials (when required) to likely pathogens and local resistance patterns and encouraging clinicians to discontinue antimicrobials if co-infection was deemed unlikely and tests confirmed that patients did not have a bacterial infection.

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