Karaba Sara M, Jones George, Helsel Taylor, Smith L Leigh, Avery Robin, Dzintars Kathryn, Salinas Alejandra B, Keller Sara C, Townsend Jennifer L, Klein Eili, Amoah Joe, Garibaldi Brian T, Cosgrove Sara E, Fabre Valeria
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Armstrong Institute for Patient Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2020 Dec 21;8(1):ofaa578. doi: 10.1093/ofid/ofaa578. eCollection 2021 Jan.
Bacterial infections may complicate viral pneumonias. Recent reports suggest that bacterial co-infection at time of presentation is uncommon in coronavirus disease 2019 (COVID-19); however, estimates were based on microbiology tests alone. We sought to develop and apply consensus definitions, incorporating clinical criteria to better understand the rate of co-infections and antibiotic use in COVID-19.
A total of 1016 adult patients admitted to 5 hospitals in the Johns Hopkins Health System between March 1, 2020, and May 31, 2020, with COVID-19 were evaluated. Adjudication of co-infection using definitions developed by a multidisciplinary team for this study was performed. Both respiratory and common nonrespiratory co-infections were assessed. The definition of bacterial community-acquired pneumonia (bCAP) included proven (clinical, laboratory, and radiographic criteria plus microbiologic diagnosis), probable (clinical, laboratory, and radiographic criteria without microbiologic diagnosis), and possible (not all clinical, laboratory, and radiographic criteria met) categories. Clinical characteristics and antimicrobial use were assessed in the context of the consensus definitions.
Bacterial respiratory co-infections were infrequent (1.2%); 1 patient had proven bCAP, and 11 (1.1%) had probable bCAP. Two patients (0.2%) had viral respiratory co-infections. Although 69% of patients received antibiotics for pneumonia, the majority were stopped within 48 hours in patients with possible or no evidence of bCAP. The most common nonrespiratory infection was urinary tract infection (present in 3% of the cohort).
Using multidisciplinary consensus definitions, proven or probable bCAP was uncommon in adults hospitalized due to COVID-19, as were other nonrespiratory bacterial infections. Empiric antibiotic use was high, highlighting the need to enhance antibiotic stewardship in the treatment of viral pneumonias.
细菌感染可能使病毒性肺炎复杂化。近期报告表明，2019冠状病毒病（COVID-19）患者就诊时合并细菌感染并不常见；然而，相关估计仅基于微生物学检测。我们试图制定并应用纳入临床标准的共识定义，以更好地了解COVID-19患者合并感染率及抗生素使用情况。
对2020年3月1日至2020年5月31日期间约翰·霍普金斯医疗系统5家医院收治的1016例成年COVID-19患者进行评估。采用多学科团队为本研究制定的定义对合并感染进行判定。同时评估呼吸道和常见非呼吸道合并感染情况。细菌性社区获得性肺炎（bCAP）的定义包括确诊（临床、实验室、影像学标准及微生物学诊断）、疑似（临床、实验室、影像学标准但无微生物学诊断）和可能（未满足所有临床、实验室及影像学标准）类别。根据共识定义评估临床特征及抗菌药物使用情况。
细菌性呼吸道合并感染较少见（1.2%）；1例患者确诊为bCAP，11例（1.1%）疑似bCAP。2例患者（0.2%）合并病毒性呼吸道感染。尽管69%的患者因肺炎接受了抗生素治疗，但对于可能无bCAP证据或无bCAP证据的患者，大多数在48小时内停用了抗生素。最常见的非呼吸道感染是尿路感染（占队列的3%）。
采用多学科共识定义，确诊或疑似bCAP在因COVID-19住院的成人中并不常见，其他非呼吸道细菌感染情况亦如此。经验性抗生素使用比例较高，凸显了在病毒性肺炎治疗中加强抗生素管理的必要性。
