Bacterial and Viral Coinfections in Adult Patients Hospitalized With COVID-19 Throughout the Pandemic: A Multinational Cohort Study in the EuCARE Project - Scorecard - MDSpire
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Bacterial and Viral Coinfections in Adult Patients Hospitalized With COVID-19 Throughout the Pandemic: A Multinational Cohort Study in the EuCARE Project
Clinical Scorecard: Coinfections with Bacteria and Viruses in Adults Hospitalized for COVID-19 During the Pandemic: Findings from the EuCARE Multinational Cohort Study
At a Glance
Category
Detail
Condition
Bacterial and viral coinfections in adults hospitalized with COVID-19
Key Mechanisms
Community-onset bacterial and viral coinfections identified via multiple microbiological test modalities during different SARS-CoV-2 variant periods
Target Population
Adults (≥18 years) hospitalized with COVID-19 in 5 European countries
Care Setting
Hospital inpatient settings across multiple European hospitals
Key Highlights
Coinfection rates were higher during the Omicron period (7.9%) compared to wild type (2.6%), Alpha (2.0%), and Delta (3.2%) variant periods.
Omicron variant was associated with a significantly increased risk ratio of coinfection compared to preceding variants (1.88; 95% CI, 1.53–2.32; P < .001).
Presence of bacterial or viral coinfections was associated with increased in-hospital mortality (adjusted risk 1.69; 95% CI, 1.49–1.91; P < .001).
Guideline-Based Recommendations
Diagnosis
Perform microbiological testing for bacterial and viral pathogens within 1 day before to 2 days after hospital admission in COVID-19 patients.
Use multiple test modalities including blood cultures, lower respiratory tract cultures, bacterial DNA assays, urinary antigen tests, and PCR for respiratory viruses.
Management
Maintain clinical vigilance for coinfections especially during periods of Omicron variant predominance.
Consider empirical antibiotic treatment guided by microbiological findings and antimicrobial stewardship principles.
Monitoring & Follow-up
Sustain monitoring of coinfection prevalence and pathogen distribution during evolving SARS-CoV-2 variant periods.
Monitor patient outcomes including length of hospital stay, ICU admission, and mortality in relation to coinfection status.
Risks
Recognize that coinfections increase risk of in-hospital mortality in COVID-19 patients.
Be aware of the potential for increased antimicrobial resistance due to high antibiotic use despite low overall coinfection prevalence.
Patient & Prescribing Data
Adults hospitalized with COVID-19 across wild type, Alpha, Delta, and Omicron variant periods
Despite low prevalence of bacterial coinfections (~5%), antibiotic use has been high; coinfections are more prevalent during Omicron and associated with worse outcomes, underscoring need for targeted antimicrobial stewardship.
Clinical Best Practices
Implement comprehensive microbiological testing early in hospitalization to detect coinfections.
Apply antimicrobial stewardship to avoid unnecessary antibiotic use while ensuring treatment of confirmed coinfections.
Maintain heightened clinical awareness for coinfections during Omicron variant predominance due to increased prevalence and mortality risk.
Use variant-specific epidemiological data to guide empirical treatment decisions.
Continuously update clinical protocols based on emerging data on coinfection prevalence and outcomes.
by Pontus Hedberg, Karol Serwin, Maria Francesca Greco, Joana P. V. Pereira, Dovile Juozapaite, Sara De Benedittis, Francesca Bai, Nadine Lübke, Tobias Wienemann, Iuri Fanti, Florian König, Nico Pfeifer, Rolf Kaiser, Maurizio Zazzi, Alessandro Cozzi-Lepri, Daniel Naumovas, Giulia Marchetti, Milosz Parczewski, Björn-Erik Ole Jensen, Francesca Incardona, Anders Sönnerborg, Pontus Nauclér
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