Abstract
BackgroundCritically ill patients with COVID-19 are at an increased risk of developing secondary bacterial infections. These are both difficult to diagnose and are associated with an increased mortality. Metabolomics may aid clinicians in diagnosing secondary bacterial infections in COVID-19 through identification and quantification of disease specific biomarkers, with the aim of identifying underlying causative microorganisms and directing antimicrobial therapy.MethodsThis is a multi-centre prospective diagnostic observational study. Patients with COVID-19 will be recruited from critical care units in three Scottish hospitals. Three serial blood samples will be taken from patients, and an additional sample taken if a patient shows clinical or microbiological evidence of secondary infection. Samples will be analysed using LC–MS and subjected to bioinformatic processing and statistical analysis to explore the metabolite changes associated with bacterial infections in COVID-19 patients. Comparisons of the data sets will be made with standard microbiological and biochemical methods of diagnosing infection.DiscussionMetabolomics analyses may provide additional strategies for identifying secondary infections, which might permit faster initiation of specific tailored antimicrobial therapy to critically ill patients with COVID-19.
Highlights
Ill patients with COVID-19 are at an increased risk of developing secondary bacterial infections
Biomarkers such as lactate, C-reactive protein (CRP) and procalcitonin have a well-established role in identifying septic patients who are at risk of further deterioration, but as of McCreath et al BMC Infectious Diseases (2021) 21:1204 yet a specific biomarker to detect the presence of a secondary infection remains elusive [13,14,15]
Aim The primary aim of this study is to ascertain the diagnostic capability of metabolomics for identifying secondary infections in critically ill patients with COVID-19 compared with routinely collected markers of infection
Summary
Ill patients with COVID-19 are at an increased risk of developing secondary bacterial infections These are both difficult to diagnose and are associated with an increased mortality. It can be difficult to make a diagnosis of secondary infection by clinical means [12] Biomarkers such as lactate, C-reactive protein (CRP) and procalcitonin have a well-established role in identifying septic patients who are at risk of further deterioration, but as of McCreath et al BMC Infectious Diseases (2021) 21:1204 yet a specific biomarker to detect the presence of a secondary infection remains elusive [13,14,15]. Initiation of antibiotic therapy has been shown to reduce mortality in bacterial sepsis [19], unnecessary use of broad spectrum antibiotics increases the risk of side effects and promotes antimicrobial resistance [20]. Alternative diagnostic strategies to improve sensitivity and provide rapid specificity would be valuable
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