key: cord-0827537-pp41e0ls
authors: Coppola, Silvia; Ciabattoni, Arianna; Pozzi, Tommaso; Castagna, Valentina; Bassi, Gianluigi Li; Chiumello, Davide
title: Hazardous mismatch between pulmonary pathogens and antibiotic treatments in COVID-19 patients
date: 2020-07-28
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.07.019
sha: 84dd9c2a6eaa8c10da2961a89f69d2196776706f
doc_id: 827537
cord_uid: pp41e0ls

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multifocal patchy consolidation with or without interstitial changes with a peripheral distribution 3 . 23 Most patients present additional organ dysfunction including acute respiratory distress syndrome 24 (ARDS), septic shock, and cardiac, kidney and hepatic failure. Although there is no current cure for 25 COVID-19, immunomodulatory agents such as corticosteroids, tocilizumab (anti-interleukin-6 26 2 monoclonal antibody) and others have been tested to modulate the cytokine storm that often ensues 27 from this novel viral infection 4 . The main risk factor associated with these agents is the risk of 28 superimposed pulmonary coinfections.

Given that the majority of COVID-19 patients present unspecific respiratory symptoms and 30 chest radiography abnormalities, empirical antibiotic treatments are commonly prescribed before 31 and during hospitalization 5 . The recent Surviving Sepsis Campaign guidelines on the management 32 of critically ill patients with SARS-CoV-2 infection suggested empiric antimicrobials/antibacterial 33 agents (as weak recommendation with low-quality of evidence) 6 . Inflammatory markers, such as 34 procalcitonin, have been applied for antimicrobial stewardship, yet in COVID-19 inflammatory 35 biomarkers are generally elevated.

Only limited evidence has been published on pulmonary co-infections in COVID-19 patients 37 undergoing mechanical ventilation. Hence, there is urgency to identify causative pathogens in this 38 population to guide appropriate antibiotic therapy while reducing risk of drug resistance. Herein, we 39 report data from 53 COVID-19 patients admitted to ICU and on mechanical ventilation in a single-40 centre study with a median age of 57 (9) yr. Among these, 26 (49%) received empiric antibiotic 41 therapy upon hospital admission. As recommended for patients with community acquired 42 pneumonia 7 empirical therapy comprised ceftriaxone plus a macrolide or levofloxacin (in 17 43 patients, 32%), but also piperacilline-tazobactam, oxacilline and linezolid (in 9 patients, 16%). Among 53 tracheal aspirates, 16 (30%) were positive and 37 (70%) negative ( Table 1 ). The 

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