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Co-infection in critically ill patients with COVID-19: an observational cohort study from England

Baskaran, Vadsala; Lawrence, Hannah; Lansbury, Louise; Webb, Karmel; Safavi, Shahideh; Zainuddin, Izzah; Huq, Tausif; Eggleston, Charlotte; Ellis, Jayne; Thakker, Clare; Charles, Bethan; Boyd, Sara; Williams, Tom; Phillips, Claire; Redmore, Ethan; Platt, Sarah; Hamilton, Eve; Barr, Andrew; Venyo, Lucy; Wilson, Peter; Bewick, Tom; Daniel, Priya; Dark, Paul; Jeans, Adam R.; McCanny, Jamie; Edgeworth, Jonathan D.; Llewelyn, Martin J.; Schmid, Matthias L.; McKeever, Tricia M.; Beed, Martin; Shen Lim, Wei

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Authors

Vadsala Baskaran

Hannah Lawrence

Karmel Webb

Shahideh Safavi

Izzah Zainuddin

Tausif Huq

Charlotte Eggleston

Jayne Ellis

Clare Thakker

Bethan Charles

Sara Boyd

Tom Williams

Claire Phillips

Ethan Redmore

Sarah Platt

Eve Hamilton

Andrew Barr

Lucy Venyo

Peter Wilson

Tom Bewick

Priya Daniel

Paul Dark

Adam R. Jeans

Jamie McCanny

Jonathan D. Edgeworth

Martin J. Llewelyn

Matthias L. Schmid

TRICIA MCKEEVER tricia.mckeever@nottingham.ac.uk
Professor of Epidemiology and Medical Statistics

Martin Beed

Wei Shen Lim



Abstract

Introduction: During previous viral pandemics, reported co-infection rates and implicated pathogens have varied. In the 1918 influenza pandemic, a large proportion of severe illness and death was complicated by bacterial co-infection, predominantly Streptococcus pneumoniae and Staphylococcus aureus.

Hypothesis/ Gap statement: A better understanding of the incidence of co-infection in patients with COVID-19 infection and the pathogens involved is necessary for effective antimicrobial stewardship.

Aim: To describe the incidence and nature of co-infection in critically ill adults with COVID-19 infection in England.

Methodology:
A retrospective cohort study of adults with COVID-19 admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at ?48 and >48 hours following hospital admission, corresponding to community and hospital-acquired co-infections.

Results:
Of 254 patients studied (median age 59 years (IQR 49-69); 64.6% male), 139 clinically significant organisms were identified from 83(32.7%) patients. Bacterial co-infections/ co-colonisation were identified within 48 hours of admission in 14(5.5%) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae and Escherichia coli. The co-infection/ co-colonisation rate >48 hours after admission was 27/1000 person-days (95% CI 21.3-34.1). Patients with co-infections/ co-colonisation were more likely to die in ICU (crude OR 1.78,95% CI 1.03-3.08, p=0.04) compared to those without co-infections/ co-colonisation.

Conclusion:
We found limited evidence for community-acquired bacterial co-infection in hospitalised adults with COVID-19, but a high rate of Gram-negative infection acquired during ICU stay.

Citation

Baskaran, V., Lawrence, H., Lansbury, L., Webb, K., Safavi, S., Zainuddin, I., …Shen Lim, W. (2021). Co-infection in critically ill patients with COVID-19: an observational cohort study from England. Journal of Medical Microbiology, 70(4), Article 001350. https://doi.org/10.1099/jmm.0.001350

Journal Article Type Article
Acceptance Date Mar 12, 2021
Online Publication Date Apr 16, 2021
Publication Date Apr 16, 2021
Deposit Date Mar 15, 2021
Publicly Available Date Apr 16, 2021
Journal Journal of Medical Microbiology
Print ISSN 0022-2615
Electronic ISSN 1473-5644
Publisher Microbiology Society
Peer Reviewed Peer Reviewed
Volume 70
Issue 4
Article Number 001350
DOI https://doi.org/10.1099/jmm.0.001350
Keywords Microbiology (medical); Microbiology; General Medicine
Public URL https://nottingham-repository.worktribe.com/output/5395699
Publisher URL https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.001350

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