Authors: Rawson TM, Wilson RC, Holmes A
PMID: 32979569 PMCID: PMC7546203 DOI: 10.1016/j.cmi.2020.09.025
Abstract
The novel coronavirus disease (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed an unprecedented strain on healthcare systems. An emerging concern is the potential impact of the novel coronavirus SARS-CoV-2 pandemic on antimicrobial resistance (AMR).
Early literature reported low rates of bacterial and fungal infection in hospitalized COVID-19 patients but high use of empirical broad-spectrum antimicrobials. In hospitals, the difficulty in clinically differentiating COVID-19 and its progression from bacterial and fungal infection provides a significant challenge to clinicians and antimicrobial stewardship. High-quality evidence to support decision-making on bacterial and fungal infection in COVID-19 is limited. Clinical uncertainty is likely to drive unnecessary antimicrobial prescribing in COVID-19 patients both on and during admission, potentially increasing the selection of drug-resistant infections.
In this issue of Clinical Microbiology and Infection, Garcia-Vidal and colleagues report their experience of co-infection and superinfection in hospitalized patients with COVID-19. Of 989 patients with COVID-19 admitted to a hospital in Barcelona, Spain, 31/989 (3%) presented with community-acquired co-infections. The majority of these were respiratory bacterial infections with Streptococcus pneumoniae and Staphylococcus aureus pneumonia. Hospital-acquired infection was diagnosed in 43/989 patients (4%), with 25/44 (57%) occurring in critical care. Ventilator-associated pneumonia, hospital-acquired pneumonia, and bacteraemia were common infections amongst that 4%, with usual nosocomial organisms predominating. These included Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., and Staphylococcus aureus. Coagulase-negative staphylococci were the most common organisms causing documented bloodstream infection (7/16; 44%). Fungal co-infection was identified in 7/989 patients (0.7%). Three patients were diagnosed with Aspergillus fumigatus tracheobronchitis and four patients with Candida albicans bloodstream infection (n = 2), urinary tract infection (n = 1), and intra-abdominal infection (n = 1).
Keywords: Antimicrobial resistance; Antimicrobial stewardship; COVID; Coinfection; Healthcare-associated infection.
