Infectious Disease

Lung bacterial superinfections are unusual in individuals who have died from COVID-19

February 22, 2021

2 min read

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Clancy reports that he has received researcher-initiated research grants from Astellas, Cidara, Melinta, Merck, and for studies unrelated to this project and on advisory boards or consultations for Astellas, Cidara, the Medicines Company, Merck, Needham & Company , Qpex, Scynexis, Shionogi and speaks at symposia sponsored by Merck and T2Biosystems. In the study you will find all relevant financial information from all other authors.

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Up to 32% of people who died with COVID-19 had a bacterial pulmonary superinfection, according to a review of post-mortem studies.

The researchers said the review, which revealed “uneven” data quality in such studies, showed that lung bacterial superinfections “complicated a minority of COVID-19 cases worldwide in the first few months of the pandemic and were rarely the cause of death. ”

Cornelius (Neil) J. Clancy

“There is still a great deal of uncertainty about the extent to which bacterial superinfections complicate COVID-19 and how antimicrobial-resistant infections are occurring.” Cornelius (Neil) J. Clancy, MD, said Healio, associate professor of medicine and director of the Comprehensive Drug Resistant Pathogen Laboratory and Mycology Program at the University of Pittsburgh.

“This is partly because many studies on COVID-19 patients have not used strict criteria for defining or classifying bacterial infections, and superinfections are difficult to diagnose clinically because the SARS-CoV-2 infection itself has comparable signs, symptoms and organ diseases. Clancy said. “We hypothesized that post-mortem tissue studies would offer an alternative way to answer questions about COVID-19-associated bacterial infections.”

Clancy and colleagues reviewed post-mortem studies in patients with COVID-19 published by September 26, 2020 for histopathological findings related to a bacterial lung infection. According to the study, 621 patients from 75 studies were included.

They said the quality of the data was uneven, “probably because identifying superinfections was not a primary goal in 96% of the studies.” They found that 200 out of 621 (32%) patients reported histopathology associated with possible pulmonary superinfection.

According to the study, the types of infection were pneumonia (95%), of which 75% were localized in a specific area and were not more common in lung abscesses or empyema (3.5%) and septic embolisms (1.5%). Superinfection was detected by direct visualization or recovery of bacteria in 25.5% of potential cases and 8% of all patients in post-mortem studies, Clancy and colleagues reported.

According to the study, the pathogens included Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae. Overall, pulmonary superinfections caused death in 16% of patients with potential bacterial infections “who have been identified as causing death,” and only 3% of all patients with COVID-19, Clancy and colleagues reported.

Among the studies with available data, 79% of patients received antimicrobial treatment, with the most common drugs being beta-lactam / beta-lactamase inhibitors (48%), macrolides (16%), cephalosporins (12%), and carbapenems (6%) were. .

“Bacterial lung infections occur in a minority of patients who die from COVID-19. Most cases are localized and of unclear clinical significance given COVID-19-related pulmonary pathology. They are rarely the cause of death,” Clancy said. “While patients with COVID-19, like all hospital patients and patients with ICRs, are at risk for bacterial infections, the data again draws attention to the importance of antimicrobial treatment. Most patients with COVID-19 do not develop bacterial superinfections and do not need antibiotics. “

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