Public Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada.
Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, ON, Canada; University of Toronto, ON, Canada; Toronto General Hospital Research Institute, ON, Canada.
Clin Microbiol Infect. 2020 Dec;26(12):1622-1629. doi: 10.1016/j.cmi.2020.07.016. Epub 2020 Jul 22.
Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood.
To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19.
We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020. Studies were included if they (a) evaluated patients with confirmed COVID-19 and (b) reported the prevalence of acute bacterial infection.
Data were extracted by a single reviewer and cross-checked by a second reviewer. The main outcome was the proportion of COVID-19 patients with an acute bacterial infection. Any bacteria detected from non-respiratory-tract or non-bloodstream sources were excluded. Of 1308 studies screened, 24 were eligible and included in the rapid review representing 3338 patients with COVID-19 evaluated for acute bacterial infection. In the meta-analysis, bacterial co-infection (estimated on presentation) was identified in 3.5% of patients (95%CI 0.4-6.7%) and secondary bacterial infection in 14.3% of patients (95%CI 9.6-18.9%). The overall proportion of COVID-19 patients with bacterial infection was 6.9% (95%CI 4.3-9.5%). Bacterial infection was more common in critically ill patients (8.1%, 95%CI 2.3-13.8%). The majority of patients with COVID-19 received antibiotics (71.9%, 95%CI 56.1 to 87.7%).
Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.
细菌共病原体在病毒性呼吸道感染中经常被发现，是发病率和死亡率的重要原因。目前尚不清楚 SARS-CoV-2 感染患者的细菌感染发生率。
确定 COVID-19 患者（就诊时）细菌合并感染（同时感染）和继发感染（就诊后感染）的发生率。
我们系统检索了 MEDLINE、OVID Epub 和 EMBASE 数据库，检索 2019 年至 2020 年 4 月 16 日的英文文献。纳入标准为：（a）评估确诊 COVID-19 患者；（b）报告急性细菌感染发生率的研究。
由一名评审员提取数据，由另一名评审员交叉核对。主要结局为 COVID-19 患者急性细菌感染的比例。任何非呼吸道或非血流来源的细菌均被排除。对 1308 项研究进行筛选后，24 项研究符合纳入标准，对 3338 例 COVID-19 患者进行了急性细菌感染评估，被纳入快速综述。Meta 分析显示，就诊时合并细菌感染的患者比例为 3.5%（95%CI 0.4-6.7%），继发细菌感染的患者比例为 14.3%（95%CI 9.6-18.9%）。COVID-19 患者的总体细菌感染率为 6.9%（95%CI 4.3-9.5%）。危重症患者的细菌感染更为常见（8.1%，95%CI 2.3-13.8%）。大多数 COVID-19 患者接受了抗生素治疗（71.9%，95%CI 56.1-87.7%）。
COVID-19 住院患者的细菌合并感染相对少见。这些患者中大多数可能不需要经验性抗菌治疗。
