Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of an
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ORIGINAL ARTICLE
Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship Kathrin Rothe 1 & Susanne Feihl 1 & Jochen Schneider 2 & Fabian Wallnöfer 2 & Milena Wurst 2 & Marina Lukas 2 & Matthias Treiber 2 & Tobias Lahmer 2 & Markus Heim 3 & Michael Dommasch 4 & Birgit Waschulzik 5 & Alexander Zink 6 & Christiane Querbach 7 & Dirk H. Busch 1,8 & Roland M. Schmid 2 & Gerhard Schneider 3 & Christoph D. Spinner 2,8 Received: 2 July 2020 / Accepted: 1 October 2020 # The Author(s) 2020
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. Keywords COVID-19 . Antibiotic stewardship . Bacterial co-infections . Diagnostic stewardship
Supplementary Information The online version of this article (https:// doi.org/10.1007/s10096-020-04063-8) contains supplementary material, which is available to authorized users. * Kathrin Rothe [email protected] 1
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Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Trogerstr. 30, 81675 Munich, Germany Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine,
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