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Baskaran V, Lawrence H, Lansbury LE, Webb K, Safavi S, Zainuddin NI, Huq T, Eggleston C, Ellis J, Thakker C, Charles B, Boyd S, Williams T, Phillips C, Redmore E, Platt S, Hamilton E, Barr A, Venyo L, Wilson P, Bewick T, Daniel P, Dark P, Jeans AR, McCanny J, Edgeworth JD, Llewelyn MJ, Schmid ML, McKeever TM, Beed M, Lim WS. Co-infection in critically ill patients with COVID-19: an observational cohort study from England. J Med Microbiol 2021; 70:001350. [PMID: 33861190 PMCID: PMC8289210 DOI: 10.1099/jmm.0.001350] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction. During previous viral pandemics, reported co-infection rates and implicated pathogens have varied. In the 1918 influenza pandemic, a large proportion of severe illness and death was complicated by bacterial co-infection, predominantly Streptococcus pneumoniae and Staphylococcus aureus.Gap statement. A better understanding of the incidence of co-infection in patients with COVID-19 infection and the pathogens involved is necessary for effective antimicrobial stewardship.Aim. To describe the incidence and nature of co-infection in critically ill adults with COVID-19 infection in England.Methodology. A retrospective cohort study of adults with COVID-19 admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at <48 and >48 h following hospital admission, corresponding to community and hospital-acquired co-infections.Results. Of 254 patients studied (median age 59 years (IQR 49-69); 64.6 % male), 139 clinically significant organisms were identified from 83 (32.7 %) patients. Bacterial co-infections/ co-colonisation were identified within 48 h of admission in 14 (5.5 %) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae and Escherichia coli. The co-infection/ co-colonisation rate >48 h after admission was 27/1000 person-days (95 % CI 21.3-34.1). Patients with co-infections/ co-colonisation were more likely to die in ICU (crude OR 1.78,95 % CI 1.03-3.08, P=0.04) compared to those without co-infections/ co-colonisation.Conclusion. We found limited evidence for community-acquired bacterial co-infection in hospitalised adults with COVID-19, but a high rate of Gram-negative infection acquired during ICU stay.
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Affiliation(s)
- Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Hannah Lawrence
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Louise E. Lansbury
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - Karmel Webb
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - Shahideh Safavi
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK
| | - Nurul I. Zainuddin
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Tausif Huq
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Charlotte Eggleston
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
| | - Jayne Ellis
- University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London NW1 2PG, UK
| | - Clare Thakker
- University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London NW1 2PG, UK
| | - Bethan Charles
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Sara Boyd
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Tom Williams
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Claire Phillips
- Brighton and Sussex University Hospitals NHS trust, Eastern Road, Brighton BN2 1ES, UK
| | - Ethan Redmore
- Brighton and Sussex University Hospitals NHS trust, Eastern Road, Brighton BN2 1ES, UK
| | - Sarah Platt
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Eve Hamilton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Andrew Barr
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Lucy Venyo
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Peter Wilson
- University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London NW1 2PG, UK
| | - Tom Bewick
- University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Priya Daniel
- University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Paul Dark
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
- Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, M23 9PT, UK
| | - Adam R. Jeans
- Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK
| | - Jamie McCanny
- Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | | | - Martin J. Llewelyn
- Brighton and Sussex University Hospitals NHS trust, Eastern Road, Brighton BN2 1ES, UK
| | - Matthias L. Schmid
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Tricia M. McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Martin Beed
- Department of Critical Care, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- Division of Anaesthesia, School of Medicine, University of Nottingham, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
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