Patients with COVID-19 frequently receive antimicrobials despite low rate of bacterial coinfections
Patients with coronavirus-related respiratory infections are often prescribed broad-spectrum empirical antimicrobials despite scarce evidence for bacterial or fungal co-infections, according to a review in Clinical Infectious Diseases.
“Antimicrobial therapy has a role in the treatment of suspected or confirmed bacterial or fungal (bacterial/fungal) respiratory coinfection. This may be empiric or targeted in patients presenting to hospital or for the management of nosocomial infection acquired during admission to hospital, such as hospital-acquired pneumonia or ventilator-associated pneumonia,” Timothy Miles Rawson, PhD, MBBS, BSc, MRCP, honorary clinical research fellow at Imperial College London’s Hammersmith Hospital, and colleagues wrote. “In terms of antimicrobial prescribing [for] bacterial/fungal coinfection of the respiratory tract, some patients presenting to hospital with SARS-COV-2 infection have a clinical phenotype that is not dissimilar from atypical bacterial pneumonia.”
Patients with COVID-19 are often febrile with respiratory symptoms, such as a dry cough, and experience bilateral chest x-ray changes, the researchers noted. As a result, “it is not unreasonable” to treat patients empirically with antimicrobials for bacterial/fungal pneumonia.
Rawson and colleagues searched MEDLINE, EMBASE and Web of Science for studies relating to coronavirus infection, including SARS-1, MERS and SARS-CoV-2, and bacterial and fungal coinfection. The search resulted in 1,007 abstracts.
According to the study, 18 full-text studies discussed bacterial/fungal coinfection; most of the studies did not identify or report these types of coinfection. Of the 18 that did report on bacterial/fungal coinfection, nine of them reviewed COVID-19, five reviewed SARS-1, one reviewed MERS and three reviewed other coronaviruses.
The data showed that for patients with COVID-19, 62 of 806 patients experienced bacterial/fungal coinfection during hospital admission, whereas 89 of 815 patients with other coronaviruses had bacterial or fungal coinfection.
A secondary analysis of patients with COVID-19 and bacterial/fungal coinfection showed wide use of broad-spectrum antibacterials — 72% of patients in the analysis received antimicrobial therapy with no antimicrobial stewardship interventions noted. Broad-spectrum antibiotic use was also noted for the other coronaviruses.
“Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal coinfection,” the authors wrote. “Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific [to] the COVID-19 pandemic are urgently required.”