ABSTRACT
This study aims to discuss guidelines for coinfection and superinfection for COVID-19. Regarding secondary infection in hospitalized patients, pulmonary superinfection is common in severely ill patients, particularly pneumonia associated with ventilation (VAP), which can occur in one out of every three patients. Current evidence does not support the routine use of empirical antibiotics in the treatment of confirmed COVID-19 infection at the time of admission, with the exception of critically ill patients with suspected clinical-imaging criteria or immunosuppression. However, a recent meta-analysis reports that 71.9% of patients hospitalized with COVID-19 received antibiotics, despite the fact that only 6.9% of these were associated with bacterial co-infections. In patients with sequelae of acute COVID-19 or persistent COVID-19, those exposed to corticosteroid therapy, or those re-admitted to the ICU, other microorganisms (mycobacteria and fungal infections) should be considered. Coinfections, particularly bacterial ones, occur in 10%-20% of patients hospitalized for COVID-19. In Uruguay we do not have national data, and as of April 2021, no co-infections have been reported in critically ill patients (PAHO/PAHO, Weekly Report). Sometimes, defining this situation makes it possible to establish whether the patient could benefit from the use of specific therapies such as tocilizumab, long-term high-dose or low-dose corticosteroids.