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
. 2022 Dec;4(4):100246.
doi: 10.1016/j.infpip.2022.100246. Epub 2022 Sep 6.

Microbiological findings and prescribing trends in SARS- CoV-2 positive patients in two United Kingdom Hospitals

Teoh Pj  1 , Maan I  1 , Uwagwu J  1 , Odedra A  1
Affiliations

Microbiological findings and prescribing trends in SARS- CoV-2 positive patients in two United Kingdom Hospitals

Teoh Pj et al. Infect Prev Pract. 2022 Dec.

Abstract

Objective: To describe antibiotic prescribing and microbiological findings in patients admitted to two London hospitals with COVID-19.

Methods: This is a retrospective review of confirmed SARS-CoV-2 infected adults admitted between 9th February and 10th May 2020. Demographics, critical care unit (CCU) admission, antibiotic prescribing and microbiology results within 10 days of COVID-19 diagnosis were analysed.

Results: 1155 patients were identified. 32.9% (380) died. 12.4% (143) had positive microbiology. After excluding likely contaminants, 6.9% (80) had clinically significant microbiology. The most common organisms isolated from blood cultures were Escherichia coli 9.5% (7), Klebsiella pneumoniae 4.0% (3), and Staphylococcus aureus 2.7% (2). A high percentage of blood cultures yielded coagulase negative staphylococci (51/74, 68.9%) and likely represented contamination. Organisms isolated from lower respiratory tract samples included Candida albicans 44.4% (12), Staphylococcus aureus 22.2% (6), Klebsiella species 11.0% (3), Pseudomonas aeruginosa 11.0% (3), and Citrobacter species 11% (3). Legionella and pneumococcal urinary antigen tests were positive in 0/117 and 2/71 (2.8%) samples. 91% (1051) of patients received antibiotics. Clarithromycin (24.2% total antibiotic use) and amoxicillin (21%) were most frequently used, followed by piperacillin-tazobactam (12.6%), gentamicin (10.6%), co-amoxiclav (9.3%) and meropenem (3.2%). Piperacillin-tazobactam or meropenem use was associated with a higher length of stay and mortality.

Conclusions: Positive microbiology in COVID-19 patients is uncommon. Antibiotic use was widespread, despite lack of microbiological evidence of co-infection. When present, positive microbiology was more likely due to gram negative bacteria. Current local clinical and antimicrobial guidelines have incorporated these findings and recommend against routine antibiotic use in COVID-19 patients.

Keywords: Antibiotics; Antimicrobial stewardship; COVID-19; Microbiological findings; SARS-CoV-2.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Timing and identity of positive blood cultures taken within 10 days of COVID-19 diagnosis. Timing is relative to the first positive SARS-CoV-2 PCR test represented as day 0. PCR; polymerase chain reaction.
Figure 2
Figure 2
Percentage of total antibiotics used per day from 10 days prior to and after the first positive PCR test. Shown in days relative to the first positive SARS-CoV-2 test represented as day 0.
Figure 3
Figure 3
The total number of patients receiving the nine most used antibiotics within 10 days of diagnosis of COVID-19. Shown in days relative to the first positive SARS-CoV-2 test, represented as day 0. PCR; polymerase chain reaction.
See this image and copyright information in PMC

References

    1. Rawson T.M., Moore L.S.P., Zhu N., Ranganathan N., Skolimowska K., Gilchrist M., et al. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis. 2020;71(9):2459–2468. doi: 10.1093/cid/ciaa530. - DOI - PMC - PubMed
    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Lansbury L., Lim B., Baskaran V., Lim W.S. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266–275. doi: 10.1016/j.jinf.2020.05.046. - DOI - PMC - PubMed
    1. Russell C.D., Fairfield C.J., Drake T.M., Turtle L., Seaton R.A., Wootton D.G., et al. Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe. 2021;2(8):e354–e365. doi: 10.1016/S2666-5247(21)00090-2. - DOI - PMC - PubMed
    1. Langford B.J., So M., Raybardhan S., Leung V., Soucy J.R., Westwood D., et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021;27(4):520–531. doi: 10.1016/j.cmi.2020.12.018. - DOI - PMC - PubMed