ABSTRACT
BackgroundComplete reporting of seroepidemiologic studies (e.g. sampling and measurement methods, immunoassay characteristics) are critical to their interpretation, comparison, and utility in evidence synthesis. The Reporting of Seroepidemiologic studies--SARS_JCoV_J2 (ROSES-S) guideline is a reporting checklist that aims to improve the quality and transparency of reporting in SARS-CoV-2 seroepidemiological studies. While the synthesis of seroepidemiologic studies played a crucial role in public health decision-making during the COVID-19 pandemic, adherence of SARS-CoV-2 seroepidemiologic studies to the ROSES-S guideline has not yet been evaluated. ObjectivesTo evaluate the completeness of SARS-CoV-2 seroepidemiologic study reporting over the first two years of the COVID-19 pandemic by assessing adherence to the ROSES-S reporting guideline, determine whether publication of the ROSES-S guideline was associated with changes in reporting completeness, and identify study characteristics associated with reporting completeness. MethodsA stratified random sample of SARS-CoV-2 seroepidemiologic studies from the SeroTracker living systematic review database was evaluated for adherence to the ROSES-S guideline. We categorized study adherence to each reporting item in the guideline as "reported", "not reported", or "not applicable". For each reporting item we calculated the percentage of studies that were adherent. We also calculated the median and interquartile range (IQR) adherence across all items and by item domain. Piecewise and multivariable beta regression analyses were used to determine whether publication date of the ROSES-S guideline was associated with changes in the overall adherence scores and to identify study characteristics associated with overall adherence scores. Results199 studies were included and analyzed. The median adherence to reporting items was 48.1% (IQR 40.0%-55.2%) per study. Adherence to reporting items ranged from 8.8% to 72.7% per study. The laboratory methods domain (e.g. description of testing algorithm) had the lowest median adherence (33.3% [IQR 25.0%-41.7%%]), while the discussion domain had the highest median adherence (75.0% [IQR 50.0%-100.0%])). There were no significant changes in reporting adherence to ROSES-S before and after guideline publication. Article publication source (p<0.001), study risk of bias (p=0.001), and sampling method (p=0.004) were significantly associated with adherence to the ROSES-S guideline. ConclusionsThe completeness of reporting in SARS-CoV-2 seroepidemiologic studies was suboptimal, especially in laboratory methods, and was associated with key study characteristics. Publication of the ROSES-S guideline was not associated with changes in reporting practices. Given that reporting is necessary to improve the standardization and utility of seroprevalence data in evidence synthesis, authors should improve adherence to the ROSES-S guideline with support from stakeholders.
Subject(s)
COVID-19ABSTRACT
Background: Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR). ObjectivesWe conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings.MethodsWe searched MEDLINE, Embase, Web of Science (BioSIS), and Scopus from November 1, 2019 to May 28, 2021 to identify relevant articles pertaining to resistant co-infections in patients with laboratory confirmed SARS-CoV-2. Patient- and study-level analyses were conducted. We calculated pooled prevalence estimates of co-infection with resistant bacterial or fungal organisms using random effects models. Stratified meta-analysis by hospital and geographic setting was also performed to elucidate any differences. ResultsOf 1331 articles identified, 38 met inclusion criteria. A total of 1959 unique isolates were identified with 29% (569) resistant organisms identified. Co-infection with resistant bacterial or fungal organisms ranged from 0.2 to 100% among included studies. Pooled prevalence of co-infection with resistant bacterial and fungal organisms was 24% (95% CI: 8-40%; n=25 studies: I 2 =99%) and 0.3% (95% CI: 0.1-0.6%; n=8 studies: I 2 =78%), respectively. Among multi-drug resistant organisms, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Candida auris were most commonly reported. Stratified analyses found higher proportions of AMR outside of Europe and in ICU settings, though these results were not statistically significant. Patient-level analysis demonstrated >50% (n=58) mortality, whereby all but 6 patients were infected with a resistant organism. ConclusionsDuring the first 18 months of the pandemic, AMR was moderately prevalent in COVID-19 patients and varied by hospital and geography although there was substantial heterogeneity. Given the variation in patient populations within these studies, clinical settings, practice patterns, and definitions of AMR, further research is warranted to quantify AMR in COVID-19 patients to improve surveillance programs, infection prevention and control practices and antimicrobial stewardship programs globally.
Subject(s)
COVID-19 , Klebsiella InfectionsABSTRACT
Background: Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR).Objectives: We conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings.Methods: We searched MEDLINE, Embase, Web of Science (BioSIS), and Scopus from November 1, 2019 to May 28, 2021 to identify relevant articles pertaining to resistant co-infections in patients with laboratory confirmed SARS-CoV-2. Patient- and study-level analyses were conducted. We calculated pooled prevalence estimates of co-infection with resistant bacterial or fungal organisms using random effects models. Stratified meta-analysis by hospital and geographic setting was also performed to elucidate any differences.Results: Of 1331 articles identified, 38 met inclusion criteria. A total of 1959 unique isolates were identified with 29% (569) resistant organisms identified. Co-infection with resistant bacterial or fungal organisms ranged from 0·2 to 100% among included studies. Pooled prevalence of co-infection with resistant bacterial and fungal organisms was 24% (95% CI: 8-40%; n=25 studies: I 2 =99%) and 0·3% (95% CI: 0·1-0·6%; n=8 studies: I 2 =78%), respectively. Among multi-drug resistant organisms, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Candida auris were most commonly reported. Stratified analyses found higher proportions of AMR outside of Europe and in ICU settings, though these results were not statistically significant. Patient-level analysis demonstrated >50% (n=58) mortality, whereby all but 6 patients were infected with a resistant organism.Conclusions: During the first 18 months of the pandemic, AMR was moderately prevalent in COVID-19 patients and varied by hospital and geography although there was substantial heterogeneity. Given the variation in patient populations within these studies, clinical settings, practice patterns, and definitions of AMR, further research is warranted to quantify AMR in COVID-19 patients to improve surveillance programs, infection prevention and control practices and antimicrobial stewardship programs globally.Funding: The Antimicrobial Resistance - One Health Consortium is funded through the Major Innovation Fund Program of the Ministry of Jobs, Economy, and Innovation (JEI), Government of Alberta, Canada.Declaration of Interest: We declare no competing interests.