AHS’ COVID-19 Scientific Advisory Group (SAG) recently investigated the latest evidence from around the world pertaining to a key topic: Antimicrobial utilization in COVID-19 patients for suspected coinfection or superinfection
There was little evidence found describing bacterial and fungal co-pathogens associated with COVID-19. Although approximately 8% of COVID-19 positive patients appear to have co-pathogens identified across series, no ‘signal’ bacterial co-pathogens have been identified.
Despite the lack of microbiologic documentation around initial co-infection at presentation and later superinfections, the literature indicates significant and widespread antibiotic use in hospitalized COVID-19 patients across various countries. However, antibiotics have not been proven to improve clinical outcomes; in fact, the stewardship literature suggest that unnecessary antibiotic use is linked with increased risk to patients, including Clostridioides difficile colitis risk.
- Antimicrobial stewardship programs can play a key role in guiding the appropriate use of antimicrobials in patients with COVID-19. Empiric antibiotic therapy is generally not required for a classic viral pneumonia presentation unless the differential diagnosis includes community acquired pneumonia (CAP), or initial co-infection is strongly suspected based on a thorough clinical assessment. Microbiologic specimens should be collected to confirm co-diagnosis and inform treatment.
- After microbiologic specimens have been obtained, COVID-19 patients with secondary bacterial infection could be considered for empiric therapy for hospital acquired pneumonia (HAP) or ventilator associated pneumonia (VAP).
- Empiric antimicrobial therapy recommendations can be found in AHS Bugs & Drugs and SpectrumMD.
- Empiric antimicrobial therapy should be re-assessed at day 3 and then with evolution of laboratory and culture results and the patient’s clinical status, for opportunities to discontinue, de-escalate, or transition to targeted antimicrobial therapy.
- If there is evidence of bacterial CAP or HAP where cultures cannot be procured or culture results are felt to be unreliable, guideline supported duration of therapy includes a 5 day course of antibiotics for CAP and a 7 day course for HAP.
To see the complete list of Rapid Response Reports, please check the COVID-19 Scientific Advisory Group website. New reports and updates appear here on a daily basis.