Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients
Cardiff University review respiratory
First Author: Philipp K. Buehler
Journal/preprint name: medrxiv
Paper DOI: https://doi.org/10.1101/2020.09.10.20191882
Tags: Superinfections, critically ill COVID-19 patients, ICU, antibiotics
Summary
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
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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)
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124 relevant microorganisms were detected in tracheobronchial secretions (TBS), but only seven different bacterial species in 12 positive blood culture pairs
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On average clinically relevant pathogens were detected on day 10 after ICU admission
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Multidrug resistant bacteria was detected in 22.2% of patients
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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:
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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
Methodologies:
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Study Type: Prospective Cohort Study
Limitations:
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Small number of patients - Total of 45 patients, skewed towards male (77.8%)
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Majority of patients treated with empirical broad-spectrum antibiotic therapy at admission (>90%)
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Investigated only critically ill COVID-19 patients
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Single centre design