Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
Clin Microbiol Infect. 2021 Nov;27(11):1658-1665. doi: 10.1016/j.cmi.2021.05.040. Epub 2021 Jun 8.
The impact of bacterial/fungal infections on the morbidity and mortality of persons with coronavirus disease 2019 (COVID-19) remains unclear. We have investigated the incidence and impact of key bacterial/fungal infections in persons with COVID-19 in England.
We extracted laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1st January 2020 to 2nd June 2020) and blood and lower-respiratory specimens positive for 24 genera/species of clinical relevance (1st January 2020 to 30th June 2020) from Public Health England's national laboratory surveillance system. We defined coinfection and secondary infection as a culture-positive key organism isolated within 1 day or 2-27 days, respectively, of the SARS-CoV-2-positive date. We described the incidence and timing of bacterial/fungal infections and compared characteristics of COVID-19 patients with and without bacterial/fungal infection.
1% of persons with COVID-19 (2279/223413) in England had coinfection/secondary infection, of which >65% were bloodstream infections. The most common causative organisms were Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae. Cases with coinfection/secondary infections were older than those without (median 70 years (IQR 58-81) versus 55 years (IQR 38-77)), and a higher percentage of cases with secondary infection were of Black or Asian ethnicity than cases without (6.7% versus 4.1%, and 9.9% versus 8.2%, respectively, p < 0.001). Age-sex-adjusted case fatality rates were higher in COVID-19 cases with a coinfection (23.0% (95%CI 18.8-27.6%)) or secondary infection (26.5% (95%CI 14.5-39.4%)) than in those without (7.6% (95%CI 7.5-7.7%)) (p < 0.005).
Coinfection/secondary bacterial/fungal infections were rare in non-hospitalized and hospitalized persons with COVID-19, varied by ethnicity and age, and were associated with higher mortality. However, the inclusion of non-hospitalized persons with asymptomatic/mild COVID-19 likely underestimated the rate of secondary bacterial/fungal infections. This should inform diagnostic testing and antibiotic prescribing strategy.
细菌/真菌感染对 2019 年冠状病毒病（COVID-19）患者发病率和死亡率的影响尚不清楚。我们调查了英格兰 COVID-19 患者中关键细菌/真菌感染的发生率和影响。
我们从英国公共卫生部国家实验室监测系统中提取了 2020 年 1 月 1 日至 2020 年 6 月 2 日期间严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的实验室确诊病例，以及 2020 年 1 月 1 日至 2020 年 6 月 30 日期间血和下呼吸道标本中与临床相关的 24 个属/种的阳性结果（2020 年 1 月 1 日至 2020 年 6 月 30 日）。我们将合并感染和继发感染定义为 SARS-CoV-2 阳性日期后 1 天或 2-27 天内分离出培养阳性关键病原体。我们描述了细菌/真菌感染的发生率和时间，并比较了 COVID-19 患者合并和不合并细菌/真菌感染的特征。
英格兰 COVID-19 患者中 1%（2279/223413）合并感染/继发感染，其中超过 65%为血流感染。最常见的病原体为大肠埃希菌、金黄色葡萄球菌和肺炎克雷伯菌。合并感染/继发感染的病例比无感染的病例年龄更大（中位数 70 岁（IQR 58-81）与 55 岁（IQR 38-77），继发感染病例中黑人或亚洲人比例高于无感染病例（分别为 6.7%与 4.1%，9.9%与 8.2%，p<0.001）。合并感染（23.0%（95%CI 18.8-27.6%））或继发感染（26.5%（95%CI 14.5-39.4%）的 COVID-19 病例的年龄性别校正病死率高于无感染病例（7.6%（95%CI 7.5-7.7%）（p<0.005）。
非住院和住院 COVID-19 患者中合并感染/继发细菌/真菌感染少见，与种族和年龄有关，且与死亡率较高相关。然而，纳入无症状/轻症 COVID-19 的非住院患者可能低估了继发细菌/真菌感染的发生率。这应该为诊断检测和抗生素处方策略提供信息。
