tetano
Editor, Senior Moderator
Clin Microbiol Infect
. 2021 Jun 8;S1198-743X(21)00288-3.
doi: 10.1016/j.cmi.2021.05.040. Online ahead of print.
National surveillance of bacterial and fungal coinfection and secondary infection in COVID-19 patients in England: lessons from the first wave
Sarah M Gerver[SUP] 1 [/SUP], Rebecca Guy[SUP] 2 [/SUP], Kate Wilson[SUP] 2 [/SUP], Simon Thelwall[SUP] 2 [/SUP], Olisaeloka Nsonwu[SUP] 2 [/SUP], Graeme Rooney[SUP] 2 [/SUP], Colin S Brown[SUP] 2 [/SUP], Berit Muller-Pebody[SUP] 2 [/SUP], Russell Hope[SUP] 2 [/SUP], Victoria Hall[SUP] 2 [/SUP]
Affiliations
Abstract
Objectives: The impact of bacterial/fungal infections on the morbidity and mortality of persons with coronavirus disease 2019 (COVID-19) remains unclear. We have investigated the incidence and impact of key bacterial/fungal infections in persons with COVID-19 in England.
Methods: We extracted laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1st January 2020 to 2nd June 2020) and blood and lower-respiratory specimens positive for 24 genera/species of clinical relevance (1st January 2020 to 30th June 2020) from Public Health England's national laboratory surveillance system. We defined coinfection and secondary infection as a culture-positive key organism isolated within 1 day or 2-27 days, respectively, of the SARS-CoV-2-positive date. We described the incidence and timing of bacterial/fungal infections and compared characteristics of COVID-19 patients with and without bacterial/fungal infection.
Results: 1% of persons with COVID-19 (2279/223413) in England had coinfection/secondary infection, of which >65% were bloodstream infections. The most common causative organisms were Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae. Cases with coinfection/secondary infections were older than those without (median 70 years (IQR 58-81) versus 55 years (IQR 38-77)), and a higher percentage of cases with secondary infection were of Black or Asian ethnicity than cases without (6.7% versus 4.1%, and 9.9% versus 8.2%, respectively, p < 0.001). Age-sex-adjusted case fatality rates were higher in COVID-19 cases with a coinfection (23.0% (95%CI 18.8-27.6%)) or secondary infection (26.5% (95%CI 14.5-39.4%)) than in those without (7.6% (95%CI 7.5-7.7%)) (p < 0.005).
Conclusions: Coinfection/secondary bacterial/fungal infections were rare in non-hospitalized and hospitalized persons with COVID-19, varied by ethnicity and age, and were associated with higher mortality. However, the inclusion of non-hospitalized persons with asymptomatic/mild COVID-19 likely underestimated the rate of secondary bacterial/fungal infections. This should inform diagnostic testing and antibiotic prescribing strategy.
Keywords: Bacterial; COVID-19; Coinfection; England; Fungal; National; SARS-CoV-2; Surveillance.
. 2021 Jun 8;S1198-743X(21)00288-3.
doi: 10.1016/j.cmi.2021.05.040. Online ahead of print.
National surveillance of bacterial and fungal coinfection and secondary infection in COVID-19 patients in England: lessons from the first wave
Sarah M Gerver[SUP] 1 [/SUP], Rebecca Guy[SUP] 2 [/SUP], Kate Wilson[SUP] 2 [/SUP], Simon Thelwall[SUP] 2 [/SUP], Olisaeloka Nsonwu[SUP] 2 [/SUP], Graeme Rooney[SUP] 2 [/SUP], Colin S Brown[SUP] 2 [/SUP], Berit Muller-Pebody[SUP] 2 [/SUP], Russell Hope[SUP] 2 [/SUP], Victoria Hall[SUP] 2 [/SUP]
Affiliations
- PMID: 34481722
- DOI: 10.1016/j.cmi.2021.05.040
Abstract
Objectives: The impact of bacterial/fungal infections on the morbidity and mortality of persons with coronavirus disease 2019 (COVID-19) remains unclear. We have investigated the incidence and impact of key bacterial/fungal infections in persons with COVID-19 in England.
Methods: We extracted laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1st January 2020 to 2nd June 2020) and blood and lower-respiratory specimens positive for 24 genera/species of clinical relevance (1st January 2020 to 30th June 2020) from Public Health England's national laboratory surveillance system. We defined coinfection and secondary infection as a culture-positive key organism isolated within 1 day or 2-27 days, respectively, of the SARS-CoV-2-positive date. We described the incidence and timing of bacterial/fungal infections and compared characteristics of COVID-19 patients with and without bacterial/fungal infection.
Results: 1% of persons with COVID-19 (2279/223413) in England had coinfection/secondary infection, of which >65% were bloodstream infections. The most common causative organisms were Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae. Cases with coinfection/secondary infections were older than those without (median 70 years (IQR 58-81) versus 55 years (IQR 38-77)), and a higher percentage of cases with secondary infection were of Black or Asian ethnicity than cases without (6.7% versus 4.1%, and 9.9% versus 8.2%, respectively, p < 0.001). Age-sex-adjusted case fatality rates were higher in COVID-19 cases with a coinfection (23.0% (95%CI 18.8-27.6%)) or secondary infection (26.5% (95%CI 14.5-39.4%)) than in those without (7.6% (95%CI 7.5-7.7%)) (p < 0.005).
Conclusions: Coinfection/secondary bacterial/fungal infections were rare in non-hospitalized and hospitalized persons with COVID-19, varied by ethnicity and age, and were associated with higher mortality. However, the inclusion of non-hospitalized persons with asymptomatic/mild COVID-19 likely underestimated the rate of secondary bacterial/fungal infections. This should inform diagnostic testing and antibiotic prescribing strategy.
Keywords: Bacterial; COVID-19; Coinfection; England; Fungal; National; SARS-CoV-2; Surveillance.