Bacterial and fungal coinfection among hospitalised patients with COVID-19: A retrospective cohort study in a UK secondary care setting
File(s)
Accepted version
Author(s)
Hughes, Stephen
Troise, Oliver
Donaldson, Hugo
Mughal, Nabeela
Moore, Luke SP
Type
Journal Article
Abstract
Objectives
We investigate the incidence of bacterial and fungal co-infection of hospitalised patients with confirmed SARS-CoV-2 in this retrospective observational study across two London hospitals during the first UK wave of COVID-19.
Methods
A retrospective case-series of hospitalised patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (February 20–April 20; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza positive patients admitted during 2019/20 flu season. Patient demographics, microbiology, and clinical outcomes were analysed.
Results
836 patients with confirmed SARS-CoV-2 were included; 27/836(3.2%) had early confirmed bacterial isolates identified (0-5 days post-admission) rising to 51/836(6.1%) throughout admission. Blood cultures, respiratory samples, pneumococcal or legionella urinary antigens, and respiratory viral PCR panels were obtained from 643(77%), 112(13%), 249(30%), 246(29%) and 250(30%) COVID-19 patients, respectively. A positive blood culture was identified in 60(7.1%) patients, of which 39/60 were classified as contaminants. Bacteraemia secondary to respiratory infection was confirmed in two cases (1 community-acquired K. pneumoniae and 1 ventilator-associated E. cloacae). Line-related bacteraemia was identified in six patients (3 candida, 2 Enterococcus spp. and 1 Pseudomonas aeruginosa). All other community acquired bacteraemias(16) were attributed to non-respiratory infection. Zero concomitant pneumococcal, legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; S. aureus the most common respiratory pathogen isolated in community-acquired coinfection (4/24;16.7%) with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n=3) were attributed to line related infections. Comparable rates of positive co-infection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141;1.4%), respiratory cultures (10/38;26.1%) and pneumococcal-positive antigens (1/19;5.2%) were low.
Conclusion
We find a low frequency of bacterial co-infection in early COVID hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.
We investigate the incidence of bacterial and fungal co-infection of hospitalised patients with confirmed SARS-CoV-2 in this retrospective observational study across two London hospitals during the first UK wave of COVID-19.
Methods
A retrospective case-series of hospitalised patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (February 20–April 20; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza positive patients admitted during 2019/20 flu season. Patient demographics, microbiology, and clinical outcomes were analysed.
Results
836 patients with confirmed SARS-CoV-2 were included; 27/836(3.2%) had early confirmed bacterial isolates identified (0-5 days post-admission) rising to 51/836(6.1%) throughout admission. Blood cultures, respiratory samples, pneumococcal or legionella urinary antigens, and respiratory viral PCR panels were obtained from 643(77%), 112(13%), 249(30%), 246(29%) and 250(30%) COVID-19 patients, respectively. A positive blood culture was identified in 60(7.1%) patients, of which 39/60 were classified as contaminants. Bacteraemia secondary to respiratory infection was confirmed in two cases (1 community-acquired K. pneumoniae and 1 ventilator-associated E. cloacae). Line-related bacteraemia was identified in six patients (3 candida, 2 Enterococcus spp. and 1 Pseudomonas aeruginosa). All other community acquired bacteraemias(16) were attributed to non-respiratory infection. Zero concomitant pneumococcal, legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; S. aureus the most common respiratory pathogen isolated in community-acquired coinfection (4/24;16.7%) with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n=3) were attributed to line related infections. Comparable rates of positive co-infection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141;1.4%), respiratory cultures (10/38;26.1%) and pneumococcal-positive antigens (1/19;5.2%) were low.
Conclusion
We find a low frequency of bacterial co-infection in early COVID hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.
Date Issued
2020-10
Date Acceptance
2020-06-24
Citation
Clinical Microbiology and Infection, 2020, 26 (10), pp.1395-1399
ISSN
1198-743X
Publisher
Elsevier BV
Start Page
1395
End Page
1399
Journal / Book Title
Clinical Microbiology and Infection
Volume
26
Issue
10
Copyright Statement
© 2020 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.sciencedirect.com/science/article/pii/S1198743X20303694?via%3Dihub
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Coronavirus
Pneumonia
SARS-CoV-2
Antimicrobial Stewardship
Bacterial co-infection
Antimicrobial Stewardship
Bacterial co-infection
Coronavirus
Pneumonia
SARS-CoV-2
Age Factors
Aged
Aged, 80 and over
Bacterial Infections
Betacoronavirus
Coinfection
Community-Acquired Infections
Coronavirus Infections
Female
Hospitalization
Humans
Influenza, Human
Male
Middle Aged
Mycoses
Pandemics
Pneumonia, Viral
Respiratory Tract Infections
Retrospective Studies
Severity of Illness Index
United Kingdom
Humans
Bacterial Infections
Community-Acquired Infections
Respiratory Tract Infections
Mycoses
Pneumonia, Viral
Coronavirus Infections
Hospitalization
Severity of Illness Index
Retrospective Studies
Age Factors
Aged
Aged, 80 and over
Middle Aged
Female
Male
Influenza, Human
Pandemics
Coinfection
United Kingdom
Betacoronavirus
1103 Clinical Sciences
1117 Public Health and Health Services
Microbiology
Publication Status
Published
Date Publish Online
2020-06-27