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.
Highlights
In December 2019, patients presenting with respiratory tract infections due to a formerly unidentified microbial agent were reported in Wuhan, China
In our retrospective study setting, we cannot control if laboratory parameters were noticed prior to the antibiotic prescription in every case.Urine samples were used for lateral flow antigen test detection of Legionella pneumophila serogroup 1 and Streptococcus pneumoniae (BinaxNOW®, Abott, Chicago, USA).For microbiological workup, blood was inoculated into aerobic and anaerobic blood cultures (BCs) media (BACTECTM Plus, Becton Dickinson, Sparks, MD, USA) via an automated BC system (BACTECTM Fluorescent Series, Becton Dickinson)
The second subgroup included patients admitted to the intensive care unit (ICU) and all patients who died during hospital stay, regardless if death occurred on ICU or general ward (n = 56: severe cases)
Summary
In December 2019, patients presenting with respiratory tract infections due to a formerly unidentified microbial agent were reported in Wuhan, China. A novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was subsequently identified as the causative pathogen. Most people develop mild or uncomplicated illness, severe disease requiring hospitalisation is observed in a subset of patients [3]. Oxygen support and intensive care unit (ICU) admission are required, and complications such as acute respiratory distress syndrome (ARDS), sepsis, and multi-organ failure are observed [4, 5]. The WHO guidelines for the clinical management of COVID-19 advise clinicians to collect blood cultures (BCs) as well as respiratory samples from the upper respiratory tract for bacterial cultures, and to start empirical antimicrobial treatment only in severe cases [4]
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