Dataset Information

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis.

ABSTRACT:

Background

Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR).

Aim

To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients.

Data source

OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021.

Study eligibility

English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting.

Participants

Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting.

Methods

Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design.

Results

A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26-10.31) and 61.77% (CI 50.95-70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30-14.18).

Conclusion

Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.

SUBMITTER: Alshaikh FS

PROVIDER: S-EPMC9342726 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis.

Alshaikh Faisal Salman FS Godman Brian B Sindi Oula Nawaf ON Seaton R Andrew RA Kurdi Amanj A

PloS one 20220801 8

<h4>Background</h4>Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance ...[more]

PMID: 35913964

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Project description:IntroductionInappropriate antibiotic use in COVID-19 is often due to treatment of presumed bacterial coinfection. Predictive factors to distinguish COVID-19 from COVID-19 with bacterial coinfection or bloodstream infection are limited.MethodsWe conducted a retrospective cohort study of 595 COVID-19 patients admitted between March 8, 2020, and April 4, 2020, to describe factors associated with a bacterial bloodstream coinfection (BSI). The primary outcome was any characteristic associated with BSI in COVID-19, with secondary outcomes including 30-day mortality and days of antibiotic therapy (DOT) by antibiotic consumption (DOT/1000 patient-days). Variables of interest were compared between true BSI (n = 25) and all other COVID-19 cases (n = 570). A secondary comparison was performed between positive blood cultures with true BSI (n = 25) and contaminants (n = 33) on antibiotic use.ResultsFever (> 38 °C) (as a COVID-19 symptom) was not different between true BSI (n = 25) and all other COVID-19 patients (n = 570) (p = 0.93), although it was different as a reason for emergency department (ED) admission (p = 0.01). Neurological symptoms (ED reason or COVID-19 symptom) were significantly higher in the true BSI group (p < 0.01, p < 0.01) and were independently associated with true BSI (ED reason: OR = 3.27, p < 0.01; COVID-19 symptom: OR = 2.69, p = 0.03) on multivariate logistic regression. High (15-19.9 × 109/L) white blood cell (WBC) count at admission was also higher in the true BSI group (p < 0.01) and was independently associated with true BSI (OR = 2.56, p = 0.06) though was not statistically significant. Thirty-day mortality was higher among true BSI (p < 0.01). Antibiotic consumption (DOT/1000 patient-days) between true BSI and contaminants was not different (p = 0.34). True bloodstream coinfection was 4.2% (25/595) over the 28-day period.ConclusionTrue BSI in COVID-19 was associated with neurological symptoms and nonsignificant higher WBC, and led to overall higher 30-day mortality and worse patient outcomes.

Project description:IntroductionThe COVID-19 outbreak poses a significant threat to the patients with tuberculosis (TB). TB and COVID-19 (TB-COVID) coinfection means the disease caused by both Mycobacterium tuberculosis and SARS-CoV-2 infection. Currently, the prevalence status, treatment and outcomes of the coinfection are poorly characterised. We aimed to systematically review the evidence on this topic and provide comprehensive information to guide the control and treatment of TB-COVID coinfection.MethodsAn extensive screening was conducted using six electronic databases to search eligible studies from 1 November 2019 to 19 March 2021. Prevalence rate, treatment and outcomes of TB-COVID coinfection were extracted. Random-effects models were used to calculate mean fatality rates of coinfection with 95% CIs. The risks of bias were assessed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Study Reporting Prevalence Data and JBI Critical Appraisal Checklist for Case Report. A meta-analysis was conducted for subgroups on in-hospital fatality rate.ResultsForty-two studies were included into the analysis (35 case reports and 7 retrospective cohort studies). Nineteen countries reported coinfected patients, including high and low TB prevalence countries. The only study revealing prevalence rate came from West Cape Province, South Africa (people aged above 20 years, 0.04% until 1 June 2020 and 0.06% until 9 June 2020). The treatment regimens for coinfected patients were highly heterogeneous. The mean overall and in-hospital fatality rates of coinfection were 13.9% (95% CI: 1.6% to 26.2%) and 17.5% (95% CI: 8.9% to 26.0%). The mean in-hospital fatality rates for high-income countries (Italy and Argentina) and low/middle-income countries (LMICs) (India, Philippines, South Africa) were 6.5% (95% CI: -0.8% to ~13.9%) and 22.5% (95% CI: 19.0% to ~26.0%).ConclusionTB-COVID coinfection is common globally, and the coinfected patients suffer from higher fatality risk than patients with normal COVID-19. Outcomes shared significant differences between high-income countries and LMICs.Prospero registration numberCRD42021253660.

Dataset Information

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis.

Background

Aim

Data source

Study eligibility

Participants

Methods

Results

Conclusion

Publications

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis.

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