key: cord-0724162-s93gnfx7
authors: Youngs, Jonathan; Wyncoll, Duncan; Hopkins, Philip; Arnold, Amber; Ball, Jonathan; Bicanic, Tihana
title: Improving antibiotic stewardship in COVID-19: bacterial co-infection is less common than with influenza
date: 2020-06-25
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.056
sha: 54e6d0099144e327ff65f299dcfcbac0e281803b
doc_id: 724162
cord_uid: s93gnfx7

nan

Improving antibiotic stewardship in COVID-19: bacterial coinfection is less common than with influenza 1 This finding, which has been replicated elsewhere 2 , is hardly surprising given the challenges associated with distinguishing bacterial from viral pneumonia and that bacterial coinfection is likely to worsen an already poor prognosis in these patients 3 . Whilst the role of biomarkers such as procalcitonin is being explored, a desire to treat what is treatable is understandable but represents a threat to antibiotic stewardship 45 . In their study, Lansbury et al. found that bacterial coinfection was more common for those in intensive care (ICU) (14%, 95% CI 5-26, vs 4%, 95% CI 1-9) but only one study provided data on the timing of infection in relation to admission.

Distinguishing between bacterial co-infection acquired prior to or following ICU admission is essential when developing antibiotic prescribing policies.

Some of the concern over bacterial co-infection in COVID-19 stems from experience with influenza where bacterial co-infection is well-recognised and often the factor precipitating admission to ICU. 6 Experience is growing that the same is not true for COVID-19 7 . Whilst any patient on ICU is vulnerable to nosocomial infection, we observe that-in contrast to influenza-bacterial co-infection at ICU admission is rare. ) on bacterial coinfection warrants further study. Future research could also explore whether the rate of nosocomial infection in ICU patients with COVID-19 was artificially high at the peak of the pandemic when challenging working environments and shortages of PPE may have impeded optimal infection prevention and control practice.

Co-infections in people with COVID-19: a systematic review and meta-analysis

Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing

Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients

COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital NICE guideline [NG173] 2020

COVID-19: don't neglect antimicrobial stewardship principles!

Seasonal influenza Guidance for adult critical care units

Vardhan Madhur S. Correspondence: Low rate of bacterial co-infection in patients with COVID-19

We would like to thank the participants of the AspiFlu study and all those that made it possible as well as all the clinical staff who worked so tirelessly during the peak of the COVID-19 pandemic. 

None to declare