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Review
. 2020 Dec 3;71(9):2459-2468.
doi: 10.1093/cid/ciaa530.

Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing

Timothy M Rawson  1   2   3 , Luke S P Moore  1   4   5 , Nina Zhu  1 , Nishanthy Ranganathan  3   4 , Keira Skolimowska  3   4 , Mark Gilchrist  3   4 , Giovanni Satta  3   4 , Graham Cooke  3   4 , Alison Holmes  1   2   3   4
Affiliations
Review

Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing

Timothy M Rawson et al. Clin Infect Dis. .

Abstract

Background: To explore and describe the current literature surrounding bacterial/fungal coinfection in patients with coronavirus infection.

Methods: MEDLINE, EMBASE, and Web of Science were searched using broad-based search criteria relating to coronavirus and bacterial coinfection. Articles presenting clinical data for patients with coronavirus infection (defined as SARS-1, MERS, SARS-CoV-2, and other coronavirus) and bacterial/fungal coinfection reported in English, Mandarin, or Italian were included. Data describing bacterial/fungal coinfections, treatments, and outcomes were extracted. Secondary analysis of studies reporting antimicrobial prescribing in SARS-CoV-2 even in absence of coinfection was performed.

Results: 1007 abstracts were identified. Eighteen full texts reporting bacterial/fungal coinfection were included. Most studies did not identify or report bacterial/fungal coinfection (85/140; 61%). Nine of 18 (50%) studies reported on COVID-19, 5/18 (28%) on SARS-1, 1/18 (6%) on MERS, and 3/18 (17%) on other coronaviruses. For COVID-19, 62/806 (8%) patients were reported as experiencing bacterial/fungal coinfection during hospital admission. Secondary analysis demonstrated wide use of broad-spectrum antibacterials, despite a paucity of evidence for bacterial coinfection. On secondary analysis, 1450/2010 (72%) of patients reported received antimicrobial therapy. No antimicrobial stewardship interventions were described. For non-COVID-19 cases, bacterial/fungal coinfection was reported in 89/815 (11%) of patients. Broad-spectrum antibiotic use was reported.

Conclusions: Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal coinfection. Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic is urgently required.

Keywords: SARS-CoV-2; antimicrobial resistance; antimicrobial stewardship.

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Comment in

  • Bacterial Pneumonia in COVID-19 Critically Ill Patients: A Case Series.
    Dudoignon E, Caméléna F, Deniau B, Habay A, Coutrot M, Ressaire Q, Plaud B, Berçot B, Dépret F. Dudoignon E, et al. Clin Infect Dis. 2021 Mar 1;72(5):905-906. doi: 10.1093/cid/ciaa762. Clin Infect Dis. 2021. PMID: 32544219 Free PMC article. No abstract available.
  • Reply to Dudoignon et al.
    Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, Satta G, Cooke G, Holmes A. Rawson TM, et al. Clin Infect Dis. 2021 Mar 1;72(5):906-908. doi: 10.1093/cid/ciaa767. Clin Infect Dis. 2021. PMID: 32544234 No abstract available.
  • Bacterial Coinfection in COVID-19.
    Gil E, Martyn E, Rokadiya S, Jain S, Chin TL. Gil E, et al. Clin Infect Dis. 2021 Aug 2;73(3):e843-e845. doi: 10.1093/cid/ciaa1120. Clin Infect Dis. 2021. PMID: 32761156 Free PMC article. No abstract available.
  • Painful palatal lesion in a patient with COVID-19.
    Pauli MA, Pereira LM, Monteiro ML, de Camargo AR, Rabelo GD. Pauli MA, et al. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Jun;131(6):620-625. doi: 10.1016/j.oooo.2021.03.010. Epub 2021 Mar 28. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021. PMID: 33867304 Free PMC article. No abstract available.

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