Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Dec;26(12):1622-1629.
doi: 10.1016/j.cmi.2020.07.016. Epub 2020 Jul 22.

Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis

Bradley J Langford  1 , Miranda So  2 , Sumit Raybardhan  3 , Valerie Leung  4 , Duncan Westwood  5 , Derek R MacFadden  6 , Jean-Paul R Soucy  7 , Nick Daneman  8
Affiliations
Meta-Analysis

Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis

Bradley J Langford et al. Clin Microbiol Infect. 2020 Dec.

Abstract

Background: Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood.

Aims: To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19.

Sources: We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020. Studies were included if they (a) evaluated patients with confirmed COVID-19 and (b) reported the prevalence of acute bacterial infection.

Content: Data were extracted by a single reviewer and cross-checked by a second reviewer. The main outcome was the proportion of COVID-19 patients with an acute bacterial infection. Any bacteria detected from non-respiratory-tract or non-bloodstream sources were excluded. Of 1308 studies screened, 24 were eligible and included in the rapid review representing 3338 patients with COVID-19 evaluated for acute bacterial infection. In the meta-analysis, bacterial co-infection (estimated on presentation) was identified in 3.5% of patients (95%CI 0.4-6.7%) and secondary bacterial infection in 14.3% of patients (95%CI 9.6-18.9%). The overall proportion of COVID-19 patients with bacterial infection was 6.9% (95%CI 4.3-9.5%). Bacterial infection was more common in critically ill patients (8.1%, 95%CI 2.3-13.8%). The majority of patients with COVID-19 received antibiotics (71.9%, 95%CI 56.1 to 87.7%).

Implications: Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.

Keywords: Bacterial infections; COVID-19; Co-infection; Living review; Secondary infection.

PubMed Disclaimer

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Study flow diagram.
Fig. 2
Fig. 2
Percentage of patients with COVID-19 and bacterial co-infection or secondary infection.
Fig. 3
Fig. 3
Percentage of patients with COVID-19 and bacterial infection stratified by estimated severity of illness.
See this image and copyright information in PMC

Comment in

References

    1. Esper F.P., Spahlinger T., Zhou L. Rate and influence of respiratory virus co-infection on pandemic (H1N1) influenza disease. J Infect. 2011;63:260–266. - PMC - PubMed
    1. Klein E.Y., Monteforte B., Gupta A., Jiang W., May L., Hsieh Y.-H., et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2016;10:394–403. - PMC - PubMed
    1. Rice T.W., Rubinson L., Uyeki T.M., Vaughn F.L., John B.B., Miller R.R., et al. Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States. Crit Care Med. 2012;40:1487–1498. - PMC - PubMed
    1. Shah N.S., Greenberg J.A., McNulty M.C., Gregg K.S., Riddell J., Mangino J.E., et al. Bacterial and viral co-infections complicating severe influenza: incidence and impact among 507 US patients, 2013–14. J Clin Virol. 2016;80:12–19. - PMC - PubMed
    1. Martín-Loeches I., Sanchez-Corral A., Diaz E., Granada R.M., Zaragoza R., Villavicencio C., et al. Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus. Chest. 2011;139:555–562. - PubMed

MeSH terms

LinkOut - more resources