Low frequency of community-acquired bacterial co-infection in patients hospitalized for COVID-19 based on clinical, radiological and microbiological criteria: a retrospective cohort study.

BACKGROUND: We defined the frequency of respiratory community-acquired bacterial co-infection in patients with COVID-19, i.e. patients with a positive SARS-CoV-2 PCR or a COVID-19 Reporting and Data System (CO-RADS) score ≥ 4, based on a complete clinical assessment, including prior antibiotic use, clinical characteristics, inflammatory markers, chest computed tomography (CT) results and microbiological test results. METHODS: Our retrospective study was conducted within a cohort of prospectively included patients admitted for COVID-19 in our tertiary medical centres between 1-3-2020 and 1-6-2020. A multidisciplinary study team developed a diagnostic protocol to retrospectively categorize patients as unlikely, possible or probable bacterial co-infection based on clinical, radiological and microbiological parameters in the first 72 h of admission. Within the three categories, we summarized patient characteristics and antibiotic consumption. RESULTS: Among 281 included COVID-19 patients, bacterial co-infection was classified as unlikely in 233 patients (82.9%), possible in 35 patients (12.4%) and probable in 3 patients (1.1%). Ten patients (3.6%) could not be classified due to inconclusive data. Within 72 h of hospital admission, 81% of the total study population and 78% of patients classified as unlikely bacterial co-infection received antibiotics. CONCLUSIONS: COVID-19 patients are unlikely to have a respiratory community-acquired bacterial co-infection. This study underpins recommendations for restrictive use of antibacterial drugs in patients with COVID-19.

Low frequency of community-acquired bacterial co-infection in patients hospitalized for COVID-19 based on clinical, radiological and microbiological criteria; a retrospective cohort study. (preprint)

Background To define the frequency of respiratory community-acquired bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) based on a complete clinical assessment, including prior antibiotic use, clinical characteristics, inflammatory markers, chest computed tomography (CT) results and microbiological test results. Methods This study was conducted within a cohort of prospectively included patients admitted for COVID-19 in our tertiary medical centres between 1-3-2020 and 1-6-2020. A multidisciplinary study team developed a diagnostic protocol to retrospectively categorize patients as unlikely, possible or probable bacterial co-infection based on clinical, radiological and microbiological parameters in the first 72 hours of admission. Within the three categories, we summarized patient characteristics and antibiotic consumption. Results Among 281 included COVID-19 patients, bacterial co-infection was classified as unlikely in 233 patients (82.9%), possible in 35 patients (12.4%) and probable in 3 patients (1.1%). Ten patients (3.6%) could not be classified due to inconclusive data. Within 72 hours of hospital admission, 81% of the total study population and 78% of patients classified as unlikely bacterial co-infection received antibiotics. Conclusions COVID-19 patients are unlikely to have a respiratory community-acquired bacterial co-infection. Prospective studies should define the safety of restrictive antibiotic use in COVID-19 patients.

Long ECMO runs in patients with COVID-19 disease. A subanalysis of the ECMOVIBER study

Objective: Describe the population of patients with COVID-19 disease needing long ECMO runs and compare characteristics and outcomes with shorter runs. Methods: Descriptive analysis of the ECMOVIBER registry, including 25 ECMO centers in Spain (23) and Portugal (2). All adult COVID-19 patients requiring VVECMO between 1stMarch and 1stDecember 2020 were included. Follow-up period ended 1stDecember. Patients still with support at this time point were excluded for the analysis. Long ECMO run was defined if lasted >30D. High volume center was defined as supporting >15 COVID-19 patients during the study period. Variables described as mean(SD)/median(IQR) or frequency(percentage). For comparisons, the Chi2, Fisher's exact or Mann-Whitney U were use. Results: Of 316 patients, 266 completed the ECMO run at the end of follow up. 46(17%) received long support and 220(83%) shorter runs. Comparisons between the two cohorts are detailed in the table-figure. Patients with longer runs were older and suffered more frequently hypertension but the respiratory condition prior to ECMO was similar. Interestingly, at day 3 of support tidal volume was lower and sweep gas flow was higher in the long run cohort. Supplemental therapies such as prone positioning and CRRT were more frequently implemented in long runs and complications occurred more frequently in this group. However, neither ECMO mortality, nor hospital mortality were higher. Conclusions: In patients with extracorporeal support due to COVID-19, tidal volume and gas flow at day 3 may discriminate those needing long runs. Long runs are not associated with worse survival despite having higher complication rates.