Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Trogerstr. 30, 81675, Munich, Germany.
Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany.
Eur J Clin Microbiol Infect Dis. 2021 Apr;40(4):859-869. doi: 10.1007/s10096-020-04063-8. Epub 2020 Nov 2.
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17-99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1-13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.
新型冠状病毒病（COVID-19）由严重急性呼吸系统综合征冠状病毒 2 型（SARS-CoV-2）引起，已在全球范围内传播。细菌合并感染与呼吸道病毒感染的不良结局相关；然而，与 COVID-19 相关的微生物学和抗生素数据很少。在大流行期间，应根据抗生素管理（ABS）原则适当使用抗生素。我们对 2020 年 2 月至 4 月期间在一家德国大学医院收治的 140 例 COVID-19 患者的临床和微生物学特征进行了回顾性研究，重点关注细菌合并感染和抗菌治疗。最终随访日期为 2020 年 5 月 6 日。记录了 140 例 COVID-19 患者的临床数据：中位年龄为 63.5 岁（范围 17-99 岁）；64%为男性。根据实施的当地 ABS 指南，最常用的抗生素方案是氨苄西林/舒巴坦（41.5%），中位疗程为 6 天（范围 1-13 天）。所有病例的尿抗原检测均为阴性军团菌和肺炎链球菌。入住重症监护病房的危重症患者（n=50）中，检测到肠杆菌科（34.0%）和烟曲霉（18.0%）合并感染。入院时采集的血培养显示诊断率为 4.2%。COVID-19 患者中细菌和真菌感染少见，主要见于危重症患者。需要进一步研究评估抗菌治疗对 COVID-19 患者治疗结果的影响，以防止抗生素过度使用。ABS 指南可帮助优化 COVID-19 的管理。还需要研究重症 COVID-19 患者感染并发症的微生物模式。
