Abstract
Adverse outcomes in coronavirus infection disease‐19 (COVID‐19) patients are not always due to the direct effects of the viral infection, but often due to bacterial coinfection. However, the risk factors for such bacterial coinfection are hitherto unknown. A case‐control study was conducted to determine risk factors for bacterial infection in moderate to critical COVID‐19. Out of a total of 50 cases and 50 controls, the proportion of cases with severe/critical disease at presentation was 80% in cases compared to 30% in controls (p < 0.001). The predominant site was hospital‐acquired pneumonia (72%) and the majority were Gram‐negative organisms (82%). The overall mortality was 30%, with comparatively higher mortality among cases (42% vs. 18%; p = 0.009). There was no difference between procalcitonin levels in both groups (p = 0.883). In multivariable logistic regression analysis, significant independent association was found with severe/critical COVID‐19 at presentation (AOR: 4.42 times; 95% CI: 1.63–11.9) and use of steroids (AOR: 4.60; 95% CI: 1.24–17.05). Notably, 64% of controls were administered antibiotics despite the absence of bacterial coinfection or secondary infection. Risk factors for bacterial infections in moderate to critically ill patients with COVID‐19 include critical illness at presentation and use of steroids. There is widespread empiric antibiotic utilization in those without bacterial infection.
Highlights
COVID-19 pandemic has claimed more than 1,000,000 lives to date and its long term impact is yet to be determined
Severe or critical COVID-19 at presentation (AOR: 4.42 times; 95% CI; 1.63-11.9) and use of steroids (AOR: 4.60; 95% CI 1.24-17.05) were independently associated with risk of bacterial infections
Cases were defined as patients who had PCR confirmed moderate to severe/critical COVID-19 as per WHO criteria for severity and had evidence of bacterial infection based on isolation of bacteria in any of the culture specimens collected during admission along with symptoms and signs consistent with infection
Summary
COVID-19 pandemic has claimed more than 1,000,000 lives to date and its long term impact is yet to be determined. The incidence of bacterial co-infection in COVID-19 ranges from 3–30% [3, 4]. Zhou and colleagues showed that in the current coronavirus disease 2019 (COVID-19) pandemic, 50% of patients who died, had secondary bacterial infections, while another study showed presence of both bacterial and fungal infection [5, 6]. Due to similar clinical phenotype and difficulties in identifying COVID-19 disease from atypical bacterial pneumonia or nosocomial pneumonia some guidelines advise empirical antibiotics [7]. In a study conducted at 38 hospitals in Michigan 56.6% patients received empirical antibiotics therapy[8]
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