ArticleThe Journal of antimicrobial chemotherapy2021
Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics.
Article in The Journal of antimicrobial chemotherapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed, 49 citations in OpenAlex.
- Distinguishing Between Bacterial and Viral Community-Acquired Pneumonia in Hospitalized Adults: The Importance of Clinical, Laboratory, and Imaging Findings.Pulmonary medicine · 2026Article
- The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19.EBioMedicine · 2024Article
- Integrative genomic analysis of the lung tissue microenvironment in SARS-CoV-2 and NL63 patients.Heliyon · 2024Article
- Are C-reactive protein and procalcitonin safe and useful for antimicrobial stewardship purposes in patients with COVID-19? A scoping review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Characterization of respiratory bacterial co-infection and assessment of empirical antibiotic treatment in patients with COVID-19 at hospital admission.Scientific reports · 2023Article
- Incidence and risk factors for clinically confirmed secondary bacterial infections in patients hospitalized for coronavirus disease 2019 (COVID-19).Infection control and hospital epidemiology · 2023Article
- Kinetics of C-Reactive Protein and Procalcitonin in the Early Identification of ICU-Acquired Infections in Critically Ill COVID-19 Patients.Journal of clinical medicine · 2023Article
- Obesity Is Associated with Changes in Laboratory Biomarkers in Chilean Patients Hospitalized with COVID-19.Journal of clinical medicine · 2023Article
- COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation.Critical care (London, England) · 2023Article
- SHEA statement on antibiotic stewardship in hospitals during public health emergencies.Infection control and hospital epidemiology · 2022Article
- Review
- Antimicrobial Prescribing Patterns in Patients with COVID-19 in Russian Multi-Field Hospitals in 2021: Results of the Global-PPS Project.Tropical medicine and infectious disease · 2022Article
- Diagnostic concordance between BioFire® FilmArray® Pneumonia Panel and culture in patients with COVID-19 pneumonia admitted to intensive care units: the experience of the third wave in eight hospitals in Colombia.Critical care (London, England) · 2022Article
- Bacterial co-infections in community-acquired pneumonia caused by SARS-CoV-2, influenza virus and respiratory syncytial virus.BMC infectious diseases · 2022Article
- Biomarkers for differentiation of coronavirus disease 2019 or extracorporeal membrane oxygenation related inflammation and bacterial/fungal infections in critically ill patients: A prospective observational study.Frontiers in medicine · 2022Article
- COVID-19 and antimicrobial stewardship: lessons learned, best practices, and future implications.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2021Review
- C-reactive protein-guided use of procalcitonin in COVID-19.JAC-antimicrobial resistance · 2021Article
- Preserved C-reactive protein responses to blood stream infections following tocilizumab treatment for COVID-19.The Journal of infection · 2021Article
- Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19.Expert review of respiratory medicine · 2021Review
- Procalcitonin to Guide Antibacterial Prescribing in Patients Hospitalised with COVID-19.Antibiotics (Basel, Switzerland) · 2021Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCOVID-19 is infrequently complicated by bacterial co-infection, but antibiotic prescriptions are common. We used community-acquired pneumonia (CAP) as a benchmark to define the processes that occur in bacterial pulmonary infections, testing the hypothesis that baseline inflammatory markers and their response to antibiotic therapy could distinguish bacterial co-infection from COVID-19.
methodsRetrospective cohort study of CAP (lobar consolidation on chest radiograph) and COVID-19 (PCR detection of SARS-CoV-2) patients admitted to Royal Free Hospital (RFH) and Barnet Hospital (BH), serving as independent discovery and validation cohorts. All CAP and >90% COVID-19 patients received antibiotics on hospital admission.
resultsWe identified 106 CAP and 619 COVID-19 patients at RFH. Compared with COVID-19, CAP was characterized by elevated baseline white cell count (WCC) [median 12.48 (IQR 8.2-15.3) versus 6.78 (IQR 5.2-9.5) ×106 cells/mL, P < 0.0001], C-reactive protein (CRP) [median 133.5 (IQR 65-221) versus 86.0 (IQR 42-160) mg/L, P < 0.0001], and greater reduction in CRP 48-72 h into admission [median ΔCRP -33 (IQR -112 to +3.5) versus +14 (IQR -15.5 to +70.5) mg/L, P < 0.0001]. These observations were recapitulated in the independent validation cohort at BH (169 CAP and 181 COVID-19 patients). A multivariate logistic regression model incorporating WCC and ΔCRP discriminated CAP from COVID-19 with AUC 0.88 (95% CI 0.83-0.94). Baseline WCC >8.2 × 106 cells/mL or falling CRP identified 94% of CAP cases, and excluded bacterial co-infection in 46% of COVID-19 patients.
conclusionsWe propose that in COVID-19, absence of both elevated baseline WCC and antibiotic-related decrease in CRP can exclude bacterial co-infection and facilitate antibiotic stewardship efforts.
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