key: cord-0906778-nuk1881y authors: Lehmann, Christopher J; Pho, Mai T; Pitrak, David; Ridgway, Jessica P; Pettit, Natasha N title: Community Acquired Co-infection in COVID-19: A Retrospective Observational Experience date: 2020-07-01 journal: Clin Infect Dis DOI: 10.1093/cid/ciaa902 sha: ac03ec6173995e103c8c3f2022c4710e65465d7d doc_id: 906778 cord_uid: nuk1881y Community acquired co-infection in COVID-19 is not well defined. Current literature describes co-infection in 0-40% of COVID-19 patients. In this retrospective report, co-infection was identified in 3.7% of patients and 41% of patients admitted to intensive care (p<0.005). Despite infrequent co-infection, antibiotics were used in 69% of patients. A c c e p t e d M a n u s c r i p t 3 In December 2019, a novel coronavirus was identified as a cause of severe viral pneumonia in Wuhan China. The virus has since been characterized as SARS-CoV-2 and causes the clinical syndrome COVID-19. [1] Experience in influenza raises concern that co-infection could be a significant complication. [2] Current literature indicates co-infection in COVID-19 could range from 0-40% of patients. [3] [4] [5] [6] [7] [8] [9] [10] [11] However, few studies were designed to assess co-infection, definitions for coinfection are variable, microbiologic data are inconsistently reported, and few reports differentiate community and hospital acquired co-infection. Because of these challenges, guidelines on antibiotic use in COVID-19 patients are not strong. [12] To better describe the rates of community acquired coinfection in COVID-19 we performed a retrospective observational analysis of our experience with co-infection in COVID-19 patients. According to University of Chicago Medicine institutional policy, this project underwent a formal administrative review and was determined to be Quality Improvement. As such, this initiative was deemed not human subjects research and was therefore not reviewed by the Institutional Review Board. This project was performed at a single hospital in Chicago, Illinois. We included all COVID-19 patients hospitalized between March 1, 2020 and April 11, 2020 at University of Chicago Medical Center. Patients younger than 18 years were excluded. Data were manually extracted from the medical record into a quality improvement database. We examined date of admission, intensive care unit (ICU) admission, mortality, antibiotic administration, and microbiologic test results. Positive test results were excluded if they were collected after the fifth day of admission. The five day time period We used descriptive statistics including frequency, rates, means, and standard deviations where appropriate. Rates were calculated among all patients, unless otherwise specified. We calculated differences in proportion of co-infection between ICU patients and non-survivors using the χ 2 test. Analysis was performed in STATA ® statistical software. A c c e p t e d M a n u s c r i p t 5 A total of 321 COVID-19 patients were admitted during the evaluation period (Table 1) COVID-19 is a new infectious disease with clinical features that are still being established. The current literature suggests co-infection could range from 0-40% of patients. [3] [4] [5] [6] [7] [8] [9] [10] [11] Higher rates of co-infection have been described in ICU patients (14-31%) and non-survivors (50%). [4, 5, 7, 8] Of those that describe microbiologic data, viral co-infection was often the most frequent. [3, [5] [6] [7] 10, 11] Current reports indicate antibiotic use is high (71-100%). [3] [4] [5] 8, 11] Our analysis indicates that community acquired co-infection in COVID-19 is infrequent and often viral. We did find co-infection was more common among ICU patients. A c c e p t e d M a n u s c r i p t 6 There are limitations to this evaluation. We employed a strict definition of co-infection as microbiologically proven, which relies on sensitivity and positive predictive value of culture, nucleic acid, and urinary antigen detection. A majority of patients presented with respiratory symptoms and received empiric antibiotics, both of which could have influenced co-infection identification. This is a single center experience; our results may not be generalizable. All patients were admitted near the end of viral respiratory season in the northern hemisphere, which likely influenced our rates of viral co-infection. This report is limited to community acquired co-infection; evaluation of nosocomial, hospital acquired co-infection is beyond the scope of this report. Based on these findings, we suggest patients admitted with COVID-19 may not require antibiotic therapy. However, patients admitted to the ICU may. Due to the limitations of this project, we cannot recommend for or against the use of antibiotics in patients with COVID-19. Prospective controlled studies are needed to determine the optimal use of antibiotics in COVID-19. M a n u s c r i p t 9 Novel Coronavirus (2019-nCoV) Situation Report -22. 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