Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had severe implications on healthcare systems and the patients affected by this infectious disease. To improve outcomes for patients with COVID-19 and limit future antimicrobial resistance, there is continued urgency to improve our understanding of the rates and causative agents of secondary bacterial infections in patients with COVID‑19, and recognise whether antibiotics are being overused in patients prior to and following COVID-19 diagnosis. This article presents the results of a rapid review comparing reported rates of secondary bacterial infections with rates of antibiotic use in patients with COVID-19 predominantly in a hospital setting, within the context of treatment guidelines and recommendations. The review revealed rates of antibiotic use in patients with COVID-19 of 37–100%, far outweighing rates of secondary bacterial infections which were typically below 20%. There was a lack of consistent reporting of causative microorganisms of secondary infections, and the distinction between bacterially- and virally-induced sepsis was rarely made. Early in the pandemic, healthcare agencies published treatment guidelines recognising the importance of antimicrobial stewardship. However, many are yet to provide updated guidance detailing the most appropriate antibiotics to treat patients with concurrent COVID-19 and secondary bacterial infections in a way which limits the emergence of drug-resistant infections and does not negatively impact patient outcomes. Without significant improvements to the testing and reporting of causative organisms and corresponding updates to antimicrobial treatment guidelines, there is a risk of worsened clinical outcomes and increased burden on healthcare systems from antimicrobial resistance during the remainder of the COVID-19 pandemic and beyond.
Highlights
During the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there have so far been more than 150 million confirmed cases and over 3 million deaths worldwide; at the time of writing, cases and deaths continue to increase rapidly[1]
Information sources and search strategy During the initial review and the update, Embase and MEDLINE were searched simultaneously via OvidSP using a mixture of text words and subject headings relating to COVID-19/SARS-CoV-2 and sepsis or secondary bacterial infections
Antibiotic overuse in the hospital setting during COVID-19 may be driven by a combination of factors, including the high prevalence and severity of secondary bacterial infections in previous influenza pandemics[2,3,4,5,6], guidelines recommending empiric antibiotics for the treatment of patients presenting with severe pneumonia[40,41,42,43], and the time required to identify safe and effective antiviral and supportive therapies[44]
Summary
During the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there have so far been more than 150 million confirmed cases and over 3 million deaths worldwide; at the time of writing, cases and deaths continue to increase rapidly[1]. With evidence from previous pandemics demonstrating a link between viral infections and secondary bacterial infections, there was concern at the beginning of the COVID-19 pandemic over our the lack of understanding of whether patients infected with SARS-CoV-2 could be at increased risk of developing life-threatening secondary bacterial infections[7]. The overuse of antibiotics in previous viral pandemics has led to increases in antibiotic resistance[5]; with drug-resistant bacterial infections currently causing around 700,000 deaths globally per year, and predictions suggesting that this figure will increase to around 10 million deaths per year by 20508, antibiotic stewardship during the remainder of the COVID-19 pandemic (and in future pandemics) is of paramount importance. In light of our findings, we recommend changes to health policy and treatment guidelines to improve the clinical outcomes of patients with severe COVID-19 and to reduce the emergence of antimicrobial resistance. I suggest the authors consider summarising the guideline changes in the introduction
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