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First Author: Philipp K. Buehler 

Journal/preprint name: medrxiv 

Paper DOI: 

Tags: Superinfections, critically ill COVID-19 patients, ICU, antibiotics 


Isolation of relevant respiratory bacteria associated with more severe disease course, prolonged ICU stay and use of ventilators in critically ill COVID-19 patients. Mainly gram-negative pathogens were isolated, in line with previous studies and the authors list the most frequently isolated bacteria and fungi detected. Authors conclude that, based on the superinfections identified, broad-spectrum antimicrobial therapy could be stopped and patients only treated if bacteria are detected, which may reduce the prevalence of drug-resistant bacteria. 

Research Highlights  

  1.  Clinically relevant bacterium or fungus was detected in 42.2% of patients (higher than previously recorded, although this could be due to strict sample collection schedule and the severely ill patients in the cohort) 

  1.  124 relevant microorganisms were detected in tracheobronchial secretions (TBS), but only seven different bacterial species in 12 positive blood culture pairs 

  1. On average clinically relevant pathogens were detected on day 10 after ICU admission 

  1. Multidrug resistant bacteria was detected in 22.2% of patients 

  1. Patients with pulmonary superinfections had substantially lower 28-day ventilator-free survival than those without and they were ventilated for significantly longer, had significantly longer stays in the ICU and increased hospitalization time. 

Impact for COVID-19 research:  

  • Identifying the bacterial strain means it can be treated specifically rather than with broad-spectrum antibiotics, resulting in a reduction of morbidity and mortality in COVID-19 patients  


  • Study TypeProspective Cohort Study  


  • Small number of patients - Total of 45 patients, skewed towards male (77.8%) 

  • Majority of patients treated with empirical broad-spectrum antibiotic therapy at admission (>90%) 

  • Investigated only critically ill COVID-19 patients  

  • Single centre design