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Review
. 2022 Apr;28(4):491-501.
doi: 10.1016/j.cmi.2021.11.008. Epub 2021 Nov 26.

Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression

Bradley J Langford  1 , Miranda So  2 , Valerie Leung  3 , Sumit Raybardhan  4 , Jennifer Lo  5 , Tiffany Kan  6 , Felicia Leung  7 , Duncan Westwood  8 , Nick Daneman  9 , Derek R MacFadden  10 , Jean-Paul R Soucy  11
Affiliations
Review

Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression

Bradley J Langford et al. Clin Microbiol Infect. 2022 Apr.

Abstract

Background: The prevalence of bacterial infection in patients with COVID-19 is low, however, empiric antibiotic use is high. Risk stratification may be needed to minimize unnecessary empiric antibiotic use.

Objective: To identify risk factors and microbiology associated with respiratory and bloodstream bacterial infection in patients with COVID-19.

Data sources: We searched MEDLINE, OVID Epub and EMBASE for published literature up to 5 February 2021.

Study eligibility criteria: Studies including at least 50 patients with COVID-19 in any healthcare setting.

Methods: We used a validated ten-item risk of bias tool for disease prevalence. The main outcome of interest was the proportion of COVID-19 patients with bloodstream and/or respiratory bacterial co-infection and secondary infection. We performed meta-regression to identify study population factors associated with bacterial infection including healthcare setting, age, comorbidities and COVID-19 medication.

Results: Out of 33 345 studies screened, 171 were included in the final analysis. Bacterial infection data were available from 171 262 patients. The prevalence of co-infection was 5.1% (95% CI 3.6-7.1%) and secondary infection was 13.1% (95% CI 9.8-17.2%). There was a higher odds of bacterial infection in studies with a higher proportion of patients in the intensive care unit (ICU) (adjusted OR 18.8, 95% CI 6.5-54.8). Female sex was associated with a lower odds of secondary infection (adjusted OR 0.73, 95% CI 0.55-0.97) but not co-infection (adjusted OR 1.05, 95% CI 0.80-1.37). The most common organisms isolated included Staphylococcus aureus, coagulase-negative staphylococci and Klebsiella species.

Conclusions: While the odds of respiratory and bloodstream bacterial infection are low in patients with COVID-19, meta-regression revealed potential risk factors for infection, including ICU setting and mechanical ventilation. The risk for secondary infection is substantially greater than the risk for co-infection in patients with COVID-19. Understanding predictors of co-infection and secondary infection may help to support improved antibiotic stewardship in patients with COVID-19.

Keywords: Antimicrobial stewardship; Bacterial infection; COVID-19; Co-infection; Risk factors; Secondary infection.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
PRISMA study flow diagram.
Fig. 2
Fig. 2
Microbiological characteristics of bacterial infection in patients with COVID-19. CNST, coagulase negative Staphylococcus spp.
Fig. 3
Fig. 3
Forest plot of co-infection and secondary infection prevalence based on healthcare setting co-infection.
Fig. 4
Fig. 4
Forest plot of co-infection and secondary infection prevalence based on specimen source.
See this image and copyright information in PMC

Comment in

References

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