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Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis
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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9828368/ https://www.ncbi.nlm.nih.gov/pubmed/36624396 http://dx.doi.org/10.1186/s12879-022-07942-x |
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author | Calderon, Maria Gysin, Grace Gujjar, Akash McMaster, Ashleigh King, Lisa Comandé, Daniel Hunter, Ewan Payne, Brendan |
author_facet | Calderon, Maria Gysin, Grace Gujjar, Akash McMaster, Ashleigh King, Lisa Comandé, Daniel Hunter, Ewan Payne, Brendan |
author_sort | Calderon, Maria |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07942-x. |
format | Online Article Text |
id | pubmed-9828368 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98283682023-01-09 Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis Calderon, Maria Gysin, Grace Gujjar, Akash McMaster, Ashleigh King, Lisa Comandé, Daniel Hunter, Ewan Payne, Brendan BMC Infect Dis Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07942-x. BioMed Central 2023-01-09 /pmc/articles/PMC9828368/ /pubmed/36624396 http://dx.doi.org/10.1186/s12879-022-07942-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Calderon, Maria Gysin, Grace Gujjar, Akash McMaster, Ashleigh King, Lisa Comandé, Daniel Hunter, Ewan Payne, Brendan Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis |
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 | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9828368/ https://www.ncbi.nlm.nih.gov/pubmed/36624396 http://dx.doi.org/10.1186/s12879-022-07942-x |
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