Original Articles

Bacterial coinfections in COVID-19: an underestimated adversary


Abstract


Current literature shows that secondary bacterial infections, although less frequent than in previous influenza pandemics, affect COVID-19 patients. Mycoplasma pneumoniae, Staphylococcus aureus, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus and Klebsiella spp. are the main species isolated. Of note, Mycobacterium tuberculosis-COVID-19 coinfections are also reported. However, bacterial coinfection rates increase in patients admitted in the intensive care units, and those diseases can be due to super-infections by nosocomial antibiotic-resistant bacteria. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and respect for the antimicrobial stewardship principles.


Keywords


COVID-19; bacterial coinfections; superinfections; antibiotics; therapy; intensive care unit

Full Text:

PDF

References


Morris DE, Cleary DW, Clarke SC. Secondary Bacterial Infections Associated with Influenza Pandemics. Front Microbiol. 2017;8:1041. DOI: 10.3389/fmicb.2017.01041

Wilder-Smith A, Green JA, Paton NI. Hospitalized patients with bacterial infections: a potential focus of SARS transmission during an outbreak. Epidemiol Infect. 2004;132(3):407-408. DOI: 10.1017/S0950268803001869

Memish ZA, Perlman S, Van Kerkhove MD, Zumla A. Middle East respiratory syndrome. Lancet. 2020;395(10229):1063–1077. DOI: 10.1016/S0140-6736(19)33221-0

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736(20)30566-3

Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, Peng Z, Pan H. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020;127:104364. DOI: 10.1016/j.jcv.2020.104364.

Easom N, Moss P, Barlow G, Samson A, Taynton T, Adams K, Ivan M, Burns P, Gajee K, Eastick K, Lillie PJ. Sixty-eight consecutive patients assessed for COVID-19 infection: Experience from a UK Regional infectious diseases Unit. Influenza Other Respir Viruses. 2020;14(4):374-379. DOI: 10.1111/irv.12739.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; and the Northwell COVID-19 Research Consortium, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-2059. DOI: 10.1001/jama.2020.6775.

Ai J-W, Zhang H-C, Xu T, Wu J, Zhu M, Yu Y-Q, Zhang H-Y, Shen Z, Li Y, Zhou X, Zang G-Q, Xu J, Chen W-J, Li YJ, Xie D-S, Zhou M-Z, Sun JY, Chen JZ, Zhang W-H. Optimizing diagnostic strategy for novel coronavirus pneumonia, a multi-center study in Eastern China. MedRxiv. 2020. DOI: 10.1101/2020.02.13.20022673

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. DOI: 10.1016/S0140-6736(20)30211-7.

Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020;55(5):1169-1174. DOI: 10.1002/ppul.24718.

Xing Q, Li G, Xing Y, Chen T, Li W, Ni W, Deng K, Gao R, Chen C, Gao Y, Li Q, Yu G, Tong J, Li W, Hao G, Sun Y, Zhang A, Wu Q, Li Z, Pan S. Precautions are Needed for COVID-19 Patients with Coinfection of Common Respiratory Pathogens. medRxiv. 2020. DOI: 10.1101/2020.02.29.20027698

Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020. ciaa272. https://doi.org/10.1093/cid/ciaa272.

Dong X, Cao YY, Lu XX, Zhang JJ, Du H, Yan YQ, Akdis CA, Gao YD. Eleven faces of coronavirus disease. Allergy. 2020. 10.1111/all.14289. DOI: 10.1111/all.14289

Lescure FX, Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S, Gaymard A, Bouscambert-Duchamp M, Donati F, Le Hingrat Q, Enouf V, Houhou-Fidouh N, Valette M, Mailles A, Lucet JC, Mentre F, Duval X, Descamps D, Malvy D, Timsit JF, Lina B, van-der-Werf S, Yazdanpanah Y. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20(6):697-706. DOI: 10.1016/S1473-3099(20)30200-0.

Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee M. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020;323(16):1612-1614. DOI: 10.1001/jama.2020.4326.

Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, Liu Y, Xiao J, Liu H, Deng D, Chen S, Zeng W, Feng L, Wu J. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(5):559-564. DOI: 10.1016/S1473-3099(20)30176-6.

Crotty MP, Akins RL, Nguyen AT, Slika R, Rahmanzadeh K, Wilson MH, Dominguez EA. Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients. medRxiv. 2020. DOI: 10.1101/2020.05.29.20117176

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. 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.

Charalampous T, Kay GL, Richardson H, Aydin A, Baldan R, Jeanes C, Rae D, Grundy S, Turner DJ, Wain J, Leggett RM, Livermore DM, O'Grady J. Nanopore metagenomics enables rapid clinical diagnosis of bacterial lower respiratory infection. Nat Biotechnol. 2019;37(7):783-792. DOI: 10.1038/s41587-019-0156-5.

Alfaraj SH, Al-Tawfiq JA, Altuwaijri TA, Memish ZA. Middle East Respiratory Syndrome Coronavirus and Pulmonary Tuberculosis Coinfection: Implications for Infection Control. Intervirology. 2017;60(1-2):53-55. DOI: 10.1159/000477908.

Wong CY, Wong KY, Law TS, Shum TT, Li YK, Pang WK. Tuberculosis in a SARS outbreak. J Chin Med Assoc. 2004;67(11):579-82. PMID: 15720073

World Health Organization. COVID-19: Considerations for tuberculosis (TB) care. https://www.who.int/docs/default-source/documents/tuberculosis/infonote-tb-covid-19.pdf

Wingfield T, Cuevas LE, MacPherson P, Millington KA, Squire SB. Tackling two pandemics: a plea on World Tuberculosis Day. Lancet Respir Med. 2020;8(6):536-538. 10.1016/S2213-2600(20)30151-X.

Togun T, Kampmann B, Stoker NG, Lipman M. Anticipating the impact of the COVID-19 pandemic on TB patients and TB control programmes. Ann Clin Microbiol Antimicrob. 2020;19(1):21. https://doi.org/10.1186/s12941-020-00363-1.

Stochino C, Villa S, Zucchi P, Parravicini P, Gori A, Raviglione MC. Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital. Eur Respir J. 2020. 2001708. DOI: 10.1183/13993003.01708-2020.

Tadolini M, Codecasa LR, García-García JM, Blanc FX, Borisov S, Alffenaar JW, Andréjak C, Bachez P, Bart PA, Belilovski E, Cardoso-Landivar J, Centis R, D'Ambrosio L, De Souza-Galvão ML, Dominguez-Castellano A, Dourmane S, Jachym MF, Froissart A, Giacomet V, Goletti D, Grard S, Gualano G, Izadifar A, Le Du D, Royo MM, Mazza-Stalder J, Motta I, Ong CWM, Palmieri F, Rivière F, Rodrigo T, Rossato Silva D, Sánchez-Montalvá A, Saporiti M, Scarpellini P, Schlemmer F, Spanevello A, Sumarokova E, Tabernero E, Tambyah PA, Tiberi S, Torre A, Visca D, Murguiondo MZ, Sotgiu G, Migliori GB. Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases. Eur Respir J. 2020. 2001398. 10.1183/13993003.01398-2020.

Motta I, Centis R, D'Ambrosio L, García-García JM, Goletti D, Gualano G, Lipani F, Palmieri F, Sánchez-Montalvá A, Pontali E, Sotgiu G, Spanevello A, Stochino C, Tabernero E, Tadolini M, van den Boom M, Villa S, Visca D, Migliori GB. Tuberculosis, COVID-19 and migrants: preliminary analysis of deaths occurring in 69 patients from two cohorts. Pulmonology. 2020. DOI: 10.1016/j.pulmoe.2020.05.002.

Rhee C, Kadri SS, Dekker JP, Danner RL, Chen H-C, Fram D, Zhang F, Wang R, Klompas M, CDC Prevention Epicenters Program. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use. JAMA Network Open. 2020;3(4):e202899. DOI: 10.1001/jamanetworkopen.2020.2899

Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles! Clin Microbiol Infect. 2020;26(7):808-810. DOI: 10.1016/j.cmi.2020.04.024


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.