Apparently bacterial superinfection translates into worse outcome when a patient is tested positive with SARS-CoV-2 and has developed symptoms. This is especially worrisome as the acquisition of any bacterial superinfection seems to be of higher likeliness in critical ill patients according to the few studies addressing the matter so far. Even more so, when we learn, that patients had acquired a bacterial superinfection despite being prescribed antibiotic prophylaxis with the onset of symptoms! We can also learn from actual data, that bacterial superinfections, occurring under prescription of empiric antibiotic medication, had a higher association with fatal outcome. The findings suggest, that patients had acquired or were colonized with a multi-resistant strain during or even prior to their hospital stay. In current publications addressing the matter, however we learn that only about 30% of the strains where resistant to the antimicrobial therapy administered. We therefore must take into consideration that there is a lack of accumulation of MIC of the antimicrobial in the respective tissue during the course of the illness in the 70% of patients, that had acquired a bacterial superinfection with normal susceptibility of the pathogen to the prescribed antimicrobial. This very scenario is held accountable for the development of resistance mechanisms in endemic pathogens. This might display a potential explanation for the selection of multi-resistant pathogens in the course of SARS-CoV-1. However, the course of SARS-CoV-1 was well controllable at that time. We are facing a different scenario in this ongoing pandemic. Whereas IFR and CFR in COVID-19 remain single digit, the wide use of empiric antibiotic prophylaxis might shift morbidity and mortality by promoting bacterial resistance to other dimensions for all of us in the long run.
Phil Geis
Article Co-infection with respiratory pathogens among COVID-2019 cases
Critical illness superinfection and antibiotic administration rates (Table 5)
Article COVID-19 with Different Severity: A Multi-center Study of Cl...
https://www.hindawi.com/journals/crj/2006/862797/
Worse outcome for bacterial superinfection (50% CFR)
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa530/5828058
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30450-X/fulltext
bacterial superinfections in minors in any viral infection: https://pediatrics.aappublications.org/content/128/6/e1450
SAR-CoV-1 and antibiotic resistance patterns:
https://academic.oup.com/cid/article/39/4/511/367125
..just would like to know what CRP values do you usually see in "normal" and critical COVID patients in the course of time. Thank you
Initially 80% present with CRP and Leuko mimicking bacterial superinfection (CRP 1-10 mg/dl, 10-12t Leukos)
I agree with the previous opinion: there is a risk of causing more harm than good
Traci L Testerman
I think we would need to consider culture-independent techniques for microbiological analysis. I fear we might yield non virulent pathogens into bacterial superinfection, when only the massive destruction of lung tissue by COVID-19 has shifted these pathogens into higher figures (comparable to a cold acquired during hayfever season). The microbiome of the lung has relatively less bacterial biomass when compared to the lower gastrointestinal tract obviously..... However, it displays considerable diversity, which is probably changed during COVID-19 and when the lung tissue is affected. Wouldn't we need a RCT critical ill administered broad AB vs placebo (ethically tough)?
I think you are right. With obvious damage to the lungs, the variety of microorganisms increases. In this case, you cannot do without effective antimicrobial agents. Antibiotic proactive use is, however, somewhat risky.
Antibiotics negatively affect people with Corona virus, and cause sensitivity and shortness of breath
Osama F. Atshan
I think there is a misunderstanding, and there is no evidence to my knowledge, that antibiotics might bear the risk of inducing sensitivity or causing shortness of breath in COVID 19. There is general evidence for adverse effects in certain patients for some antibiotics, but this is not limited to COVID-19 patients, at least to my knowledge.
This discussion's results, so far:
- Inappropriate use of antibiotics is taking place, because of a large expansion in the number of patients with respiratory tract symptoms due to COVID or not, worldwide.
- The more any bacteria are exposed to antibiotics through treatments that are unnecessary, the higher is the chance to develop resistance.
Bottom line:
- antibiotics should not be prescribed unless there's a clear indication
- Pathogen retrieval should be conducted to give guidance in antibiotic treatment of any suspected bacterial superinfection in COVID-19
- no clear denominator for empirical use of antibiotics in respiratory tract infections due toor associated with COVID-19