Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing
Open accessAbstract
BACKGROUND: To explore and describe the current literature surrounding bacterial/fungal coinfection in patients with coronavirus infection. METHODS: MEDLINE, EMBASE, and Web of Science were searched using broad-based search criteria relating to coronavirus and bacterial coinfection. Articles presenting clinical data for patients with coronavirus infection (defined as SARS-1, MERS, SARS-CoV-2, and other coronavirus) and bacterial/fungal coinfection reported in English, Mandarin, or Italian were included. Data describing bacterial/fungal coinfections, treatments, and outcomes were extracted. Secondary analysis of studies reporting antimicrobial prescribing in SARS-CoV-2 even in absence of coinfection was performed. RESULTS: 1007 abstracts were identified. Eighteen full texts reporting bacterial/fungal coinfection were included. Most studies did not identify or report bacterial/fungal coinfection (85/140; 61%). Nine of 18 (50%) studies reported on COVID-19, 5/18 (28%) on SARS-1, 1/18 (6%) on MERS, and 3/18 (17%) on other coronaviruses. For COVID-19, 62/806 (8%) patients were reported as experiencing bacterial/fungal coinfection during hospital admission. Secondary analysis demonstrated wide use of broad-spectrum antibacterials, despite a paucity of evidence for bacterial coinfection. On secondary analysis, 1450/2010 (72%) of patients reported received antimicrobial therapy. No antimicrobial stewardship interventions were described. For non-COVID-19 cases, bacterial/fungal coinfection was reported in 89/815 (11%) of patients. Broad-spectrum antibiotic use was reported. CONCLUSIONS: Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal coinfection. Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic is urgently required.
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1450/2010 (72%) of COVID-19 patients received antimicrobial therapy.
“It’s reported that 1450/2010 (72%) of COVID-19 patients received antimicrobial therapy (Rawson et al., 2020).”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Rawson et al., 2020
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- Authors
- Rawson, T. M., Moore, L. S. P., Zhu, N., Ranganathan, N., Skolimowska, K., Gilchrist, M., Satta, G., Cooke, G., & Holmes, A.
- Affiliations
- National Institute for Health and Care Research (GB)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Holmes, Alison
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-05-02
- Volume
- 71
- Issue
- 9
- Pages
- 2459-2468
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC7197596
- OpenAlex
- W3023977941
- Cited by
- 1,662
- References
- 49
- Citations by year
- 2026: 57 · 2025: 86 · 2024: 143 · 2023: 299 · 2022: 373 · 2021: 464 · 2020: 235 · 2019: 3 · 2018: 1 · 2017: 1
- FWCI
- 16.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- Centre for Antimicrobial Optimisation at Imperial College London
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Keywords
- bacterial co-infection, fungal co-infection, COVID-19 pandemic, SARS-CoV-2, MERS, antimicrobial prescribing, broad-spectrum antibiotics, antimicrobial stewardship, empirical antimicrobial therapy
- MeSH terms
- Antimicrobial Stewardship, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Anti-Infective Agents, Bacterial Infections, Drug Resistance, Microbial, Humans, Mycoses, Coinfection
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