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Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study.
Russell, Clark D; Fairfield, Cameron J; Drake, Thomas M; Turtle, Lance; Seaton, R Andrew; Wootton, Dan G; Sigfrid, Louise; Harrison, Ewen M; Docherty, Annemarie B; de Silva, Thushan I; Egan, Conor; Pius, Riinu; Hardwick, Hayley E; Merson, Laura; Girvan, Michelle; Dunning, Jake; Nguyen-Van-Tam, Jonathan S; Openshaw, Peter J M; Baillie, J Kenneth; Semple, Malcolm G; Ho, Antonia.
Afiliação
  • Russell CD; University of Edinburgh Centre for Inflammation Research, Edinburgh, UK.
  • Fairfield CJ; Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, UK.
  • Drake TM; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Turtle L; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Seaton RA; Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
  • Wootton DG; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
  • Sigfrid L; Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK.
  • Harrison EM; Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
  • Docherty AB; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
  • de Silva TI; ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Egan C; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Pius R; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Hardwick HE; South Yorkshire Regional Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
  • Merson L; Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, UK.
  • Girvan M; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Dunning J; Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
  • Nguyen-Van-Tam JS; Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
  • Openshaw PJM; ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Baillie JK; Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.
  • Semple MG; Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK.
  • Ho A; Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK.
Lancet Microbe ; 2(8): e354-e365, 2021 08.
Article em En | MEDLINE | ID: mdl-34100002
BACKGROUND: Microbiological characterisation of co-infections and secondary infections in patients with COVID-19 is lacking, and antimicrobial use is high. We aimed to describe microbiologically confirmed co-infections and secondary infections, and antimicrobial use, in patients admitted to hospital with COVID-19. METHODS: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study is an ongoing, prospective cohort study recruiting inpatients from 260 hospitals in England, Scotland, and Wales, conducted by the ISARIC Coronavirus Clinical Characterisation Consortium. Patients with a confirmed or clinician-defined high likelihood of SARS-CoV-2 infection were eligible for inclusion in the ISARIC WHO CCP-UK study. For this specific study, we excluded patients with a recorded negative SARS-CoV-2 test result and those without a recorded outcome at 28 days after admission. Demographic, clinical, laboratory, therapeutic, and outcome data were collected using a prespecified case report form. Organisms considered clinically insignificant were excluded. FINDINGS: We analysed data from 48 902 patients admitted to hospital between Feb 6 and June 8, 2020. The median patient age was 74 years (IQR 59-84) and 20 786 (42·6%) of 48 765 patients were female. Microbiological investigations were recorded for 8649 (17·7%) of 48 902 patients, with clinically significant COVID-19-related respiratory or bloodstream culture results recorded for 1107 patients. 762 (70·6%) of 1080 infections were secondary, occurring more than 2 days after hospital admission. Staphylococcus aureus and Haemophilus influenzae were the most common pathogens causing respiratory co-infections (diagnosed ≤2 days after admission), with Enterobacteriaceae and S aureus most common in secondary respiratory infections. Bloodstream infections were most frequently caused by Escherichia coli and S aureus. Among patients with available data, 13 390 (37·0%) of 36 145 had received antimicrobials in the community for this illness episode before hospital admission and 39 258 (85·2%) of 46 061 patients with inpatient antimicrobial data received one or more antimicrobials at some point during their admission (highest for patients in critical care). We identified frequent use of broad-spectrum agents and use of carbapenems rather than carbapenem-sparing alternatives. INTERPRETATION: In patients admitted to hospital with COVID-19, microbiologically confirmed bacterial infections are rare, and more likely to be secondary infections. Gram-negative organisms and S aureus are the predominant pathogens. The frequency and nature of antimicrobial use are concerning, but tractable targets for stewardship interventions exist. FUNDING: National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, UK Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and NIHR HPRU in Respiratory Infections at Imperial College London.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções Respiratórias / Coinfecção / COVID-19 / Anti-Infecciosos Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções Respiratórias / Coinfecção / COVID-19 / Anti-Infecciosos Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: Europa Idioma: En Ano de publicação: 2021 Tipo de documento: Article