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Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19

BACKGROUND: The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. METH...

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Autores principales: Lee, Jiyoung, Chang, Euijin, Jung, Jiwon, Kim, Min Jae, Chong, Yong Pil, Kim, Sung-Han, Lee, Sang-Oh, Choi, Sang-Ho, Kim, Yang Soo, Bae, Seongman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886529/
https://www.ncbi.nlm.nih.gov/pubmed/36718563
http://dx.doi.org/10.3346/jkms.2023.38.e37
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author Lee, Jiyoung
Chang, Euijin
Jung, Jiwon
Kim, Min Jae
Chong, Yong Pil
Kim, Sung-Han
Lee, Sang-Oh
Choi, Sang-Ho
Kim, Yang Soo
Bae, Seongman
author_facet Lee, Jiyoung
Chang, Euijin
Jung, Jiwon
Kim, Min Jae
Chong, Yong Pil
Kim, Sung-Han
Lee, Sang-Oh
Choi, Sang-Ho
Kim, Yang Soo
Bae, Seongman
author_sort Lee, Jiyoung
collection PubMed
description BACKGROUND: The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. METHODS: In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. RESULTS: Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. CONCLUSION: In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.
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spelling pubmed-98865292023-02-08 Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19 Lee, Jiyoung Chang, Euijin Jung, Jiwon Kim, Min Jae Chong, Yong Pil Kim, Sung-Han Lee, Sang-Oh Choi, Sang-Ho Kim, Yang Soo Bae, Seongman J Korean Med Sci Original Article BACKGROUND: The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. METHODS: In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. RESULTS: Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. CONCLUSION: In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship. The Korean Academy of Medical Sciences 2023-01-18 /pmc/articles/PMC9886529/ /pubmed/36718563 http://dx.doi.org/10.3346/jkms.2023.38.e37 Text en © 2023 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Lee, Jiyoung
Chang, Euijin
Jung, Jiwon
Kim, Min Jae
Chong, Yong Pil
Kim, Sung-Han
Lee, Sang-Oh
Choi, Sang-Ho
Kim, Yang Soo
Bae, Seongman
Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
title Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
title_full Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
title_fullStr Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
title_full_unstemmed Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
title_short Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19
title_sort bacterial co-infection and empirical antibacterial therapy in patients with covid-19
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886529/
https://www.ncbi.nlm.nih.gov/pubmed/36718563
http://dx.doi.org/10.3346/jkms.2023.38.e37
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