Russell, Clark D, Fairfield, Cameron J, Drake, Thomas M, Turtle, Lance, Seaton, R Andrew, Wootton, Dan G, Sigfrid, Louise, Harrison, Ewen M, Docherty, Annemarie B, de Silva, Thushan I, Egan, Conor, Pius, Riinu, Hardwick, Hayley E, Merson, Laura, Girvan, Michelle, Dunning, Jake, Nguyen-Van-Tam, Jonathan S, Openshaw, Peter JM, Baillie, J Kenneth, Semple, Malcolm G, Ho, Antonia, Eziefula, Chi and ISARIC4C investigators, (2021) Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe, 2 (8). e354-e365. ISSN 2666-5247

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Abstract

Background
Microbiological characterisation of co-infections and secondary infections in patients with COVID-19 is lacking, and antimicrobial use is high. We aimed to describe microbiologically confirmed co-infections and secondary infections, and antimicrobial use, in patients admitted to hospital with COVID-19.

Methods
The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study is an ongoing, prospective cohort study recruiting inpatients from 260 hospitals in England, Scotland, and Wales, conducted by the ISARIC Coronavirus Clinical Characterisation Consortium. Patients with a confirmed or clinician-defined high likelihood of SARS-CoV-2 infection were eligible for inclusion in the ISARIC WHO CCP-UK study. For this specific study, we excluded patients with a recorded negative SARS-CoV-2 test result and those without a recorded outcome at 28 days after admission. Demographic, clinical, laboratory, therapeutic, and outcome data were collected using a prespecified case report form. Organisms considered clinically insignificant were excluded.

Findings
We analysed data from 48 902 patients admitted to hospital between Feb 6 and June 8, 2020. The median patient age was 74 years (IQR 59–84) and 20 786 (42·6%) of 48 765 patients were female. Microbiological investigations were recorded for 8649 (17·7%) of 48 902 patients, with clinically significant COVID-19-related respiratory or bloodstream culture results recorded for 1107 patients. 762 (70·6%) of 1080 infections were secondary, occurring more than 2 days after hospital admission. Staphylococcus aureus and Haemophilus influenzae were the most common pathogens causing respiratory co-infections (diagnosed ≤2 days after admission), with Enterobacteriaceae and S aureus most common in secondary respiratory infections. Bloodstream infections were most frequently caused by Escherichia coli and S aureus. Among patients with available data, 13 390 (37·0%) of 36 145 had received antimicrobials in the community for this illness episode before hospital admission and 39 258 (85·2%) of 46 061 patients with inpatient antimicrobial data received one or more antimicrobials at some point during their admission (highest for patients in critical care). We identified frequent use of broad-spectrum agents and use of carbapenems rather than carbapenem-sparing alternatives.

Interpretation
In patients admitted to hospital with COVID-19, microbiologically confirmed bacterial infections are rare, and more likely to be secondary infections. Gram-negative organisms and S aureus are the predominant pathogens. The frequency and nature of antimicrobial use are concerning, but tractable targets for stewardship interventions exist.

Item Type:	Article
Keywords:	Aged, Aged, 80 and over, Anti-Infective Agents, COVID-19, Coinfection, Female, Humans, Male, Middle Aged, Pandemics, Prospective Studies, Respiratory Tract Infections, SARS-CoV-2, United Kingdom, World Health Organization
Schools and Departments:	Brighton and Sussex Medical School > Global Health and Infection
SWORD Depositor:	Mx Elements Account
Depositing User:	Mx Elements Account
Date Deposited:	13 Oct 2022 13:32
Last Modified:	22 Nov 2022 11:39
URI:	http://sro.sussex.ac.uk/id/eprint/108481

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