Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis
Abstract Introduction Understanding the proportion of patients with COVID-19 who have respiratory bacterial co-infections and the responsible pathogens is important for managing COVID-19 effectively while ensuring responsible antibiotic use. Objective To estimate the frequency of bacterial co-infect...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07942-x |
| _version_ | 1797952603417477120 |
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| author | Maria Calderon Grace Gysin Akash Gujjar Ashleigh McMaster Lisa King Daniel Comandé Ewan Hunter Brendan Payne |
| author_facet | Maria Calderon Grace Gysin Akash Gujjar Ashleigh McMaster Lisa King Daniel Comandé Ewan Hunter Brendan Payne |
| author_sort | Maria Calderon |
| collection | DOAJ |
| description | Abstract Introduction Understanding the proportion of patients with COVID-19 who have respiratory bacterial co-infections and the responsible pathogens is important for managing COVID-19 effectively while ensuring responsible antibiotic use. Objective To estimate the frequency of bacterial co-infection in COVID-19 hospitalized patients and of antibiotic prescribing during the early pandemic period and to appraise the use of antibiotic stewardship criteria. Methods Systematic review and meta-analysis was performed using major databases up to May 5, 2021. We included studies that reported proportion/prevalence of bacterial co-infection in hospitalized COVID-19 patients and use of antibiotics. Where available, data on duration and type of antibiotics, adverse events, and any information about antibiotic stewardship policies were also collected. Results We retrieved 6,798 studies and included 85 studies with data from more than 30,000 patients. The overall prevalence of bacterial co-infection was 11% (95% CI 8% to 16%; 70 studies). When only confirmed bacterial co-infections were included the prevalence was 4% (95% CI 3% to 6%; 20 studies). Overall antibiotic use was 60% (95% CI 52% to 68%; 52 studies). Empirical antibiotic use rate was 62% (95% CI 55% to 69%; 11 studies). Few studies described criteria for stopping antibiotics. Conclusion There is currently insufficient evidence to support widespread empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection is low. Furthermore, as the use of antibiotics during the study period appears to have been largely empirical, clinical guidelines to promote and support more targeted administration of antibiotics in patients admitted to hospital with COVID-19 are required. |
| first_indexed | 2024-04-10T22:50:05Z |
| format | Article |
| id | doaj.art-1532e8dfec18466bac4e33f9e014525e |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-10T22:50:05Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-1532e8dfec18466bac4e33f9e014525e2023-01-15T12:05:25ZengBMCBMC Infectious Diseases1471-23342023-01-0123112010.1186/s12879-022-07942-xBacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysisMaria Calderon0Grace Gysin1Akash Gujjar2Ashleigh McMaster3Lisa King4Daniel Comandé5Ewan Hunter6Brendan Payne7Department of Infection and Tropical Medicine, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Royal Victoria InfirmaryTranslational and Clinical Research Institute, Newcastle UniversitySchool of Medicine, Newcastle UniversityDepartment of Infection and Tropical Medicine, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Royal Victoria InfirmarySchool of Medicine, Newcastle UniversityInstituto de Efectividad Clinica y SanitariaDepartment of Infection and Tropical Medicine, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Royal Victoria InfirmaryDepartment of Infection and Tropical Medicine, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Royal Victoria InfirmaryAbstract Introduction Understanding the proportion of patients with COVID-19 who have respiratory bacterial co-infections and the responsible pathogens is important for managing COVID-19 effectively while ensuring responsible antibiotic use. Objective To estimate the frequency of bacterial co-infection in COVID-19 hospitalized patients and of antibiotic prescribing during the early pandemic period and to appraise the use of antibiotic stewardship criteria. Methods Systematic review and meta-analysis was performed using major databases up to May 5, 2021. We included studies that reported proportion/prevalence of bacterial co-infection in hospitalized COVID-19 patients and use of antibiotics. Where available, data on duration and type of antibiotics, adverse events, and any information about antibiotic stewardship policies were also collected. Results We retrieved 6,798 studies and included 85 studies with data from more than 30,000 patients. The overall prevalence of bacterial co-infection was 11% (95% CI 8% to 16%; 70 studies). When only confirmed bacterial co-infections were included the prevalence was 4% (95% CI 3% to 6%; 20 studies). Overall antibiotic use was 60% (95% CI 52% to 68%; 52 studies). Empirical antibiotic use rate was 62% (95% CI 55% to 69%; 11 studies). Few studies described criteria for stopping antibiotics. Conclusion There is currently insufficient evidence to support widespread empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection is low. Furthermore, as the use of antibiotics during the study period appears to have been largely empirical, clinical guidelines to promote and support more targeted administration of antibiotics in patients admitted to hospital with COVID-19 are required.https://doi.org/10.1186/s12879-022-07942-xBacterial co-infectionCOVID-19Antibiotic stewardship |
| spellingShingle | Maria Calderon Grace Gysin Akash Gujjar Ashleigh McMaster Lisa King Daniel Comandé Ewan Hunter Brendan Payne Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis BMC Infectious Diseases Bacterial co-infection COVID-19 Antibiotic stewardship |
| title | Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis |
| title_full | Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis |
| title_fullStr | Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis |
| title_full_unstemmed | Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis |
| title_short | Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis |
| title_sort | bacterial co infection and antibiotic stewardship in patients with covid 19 a systematic review and meta analysis |
| topic | Bacterial co-infection COVID-19 Antibiotic stewardship |
| url | https://doi.org/10.1186/s12879-022-07942-x |
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