Risk factors for bacterial infections in patients with moderate to severe COVID-19: A case-control study

J Med Virol. 2021 Jul;93(7):4564-4569. doi: 10.1002/jmv.27000. Epub 2021 Apr 15.

Abstract

Adverse outcomes in coronavirus infection disease-19 (COVID-19) patients are not always due to the direct effects of the viral infection, but often due to bacterial coinfection. However, the risk factors for such bacterial coinfection are hitherto unknown. A case-control study was conducted to determine risk factors for bacterial infection in moderate to critical COVID-19. Out of a total of 50 cases and 50 controls, the proportion of cases with severe/critical disease at presentation was 80% in cases compared to 30% in controls (p < 0.001). The predominant site was hospital-acquired pneumonia (72%) and the majority were Gram-negative organisms (82%). The overall mortality was 30%, with comparatively higher mortality among cases (42% vs. 18%; p = 0.009). There was no difference between procalcitonin levels in both groups (p = 0.883). In multivariable logistic regression analysis, significant independent association was found with severe/critical COVID-19 at presentation (AOR: 4.42 times; 95% CI: 1.63-11.9) and use of steroids (AOR: 4.60; 95% CI: 1.24-17.05). Notably, 64% of controls were administered antibiotics despite the absence of bacterial coinfection or secondary infection. Risk factors for bacterial infections in moderate to critically ill patients with COVID-19 include critical illness at presentation and use of steroids. There is widespread empiric antibiotic utilization in those without bacterial infection.

Keywords: COVID-19; bacteria; coinfection; nosocomial infections.

MeSH terms

  • Aged
  • Antimicrobial Stewardship
  • Bacterial Infections / complications
  • Bacterial Infections / epidemiology*
  • COVID-19 / etiology
  • COVID-19 / pathology*
  • Case-Control Studies
  • Coinfection / epidemiology*
  • Coinfection / microbiology
  • Female
  • Healthcare-Associated Pneumonia / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Pakistan / epidemiology
  • Risk Factors
  • SARS-CoV-2