Evidence map›Paper›PMID 34843962›Full record

ReviewClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2022

Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression.

Bradley J Langford, Miranda So, Valerie Leung, Sumit Raybardhan, Jennifer Lo, Tiffany Kan, Felicia Leung, Duncan Westwood, Nick Daneman, Derek R MacFadden and 1 more

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 4 pooled it
8.9field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 4 syntheses or guidelines pooled it, 86 citations in OpenAlex.

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  2. Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 9 institutions in 1 country.

Bradley J LangfordPublic Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada. Electronic address: brad.langford@gmail.com.
Miranda SoSinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Canada; University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
Valerie LeungPublic Health Ontario, ON, Canada; Toronto East Health Network, Michael Garron Hospital, ON Canada.
Sumit RaybardhanNorth York General Hospital, ON, Canada.
Jennifer LoSunnybrook Health Sciences Centre, ON, Canada.
Tiffany KanToronto East Health Network, Michael Garron Hospital, ON Canada.
Felicia LeungUniversity of Toronto, ON, Canada.
Duncan WestwoodSinai Health, Toronto, ON, Canada.
Nick DanemanPublic Health Ontario, ON, Canada; University of Toronto, ON, Canada; Sunnybrook Health Sciences Centre, ON, Canada; Sunnybrook Research Institute, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), ON Canada.
Derek R MacFaddenOttawa Hospital Research Institute, ON, Canada.
Jean-Paul R SoucyDivision of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
Toronto East General Hospital · CAUniversity of Toronto · CAHotel Dieu Shaver Health and Rehabilitation Centre · CAInstitute for Clinical Evaluative Sciences · CANorth York General Hospital · CAOttawa Hospital · CAPublic Health Ontario · CASinai Health System · CASunnybrook Health Science Centre · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe prevalence of bacterial infection in patients with COVID-19 is low, however, empiric antibiotic use is high. Risk stratification may be needed to minimize unnecessary empiric antibiotic use.

objectiveTo identify risk factors and microbiology associated with respiratory and bloodstream bacterial infection in patients with COVID-19. DATA SOURCES: We searched MEDLINE, OVID Epub and EMBASE for published literature up to 5 February 2021. STUDY ELIGIBILITY CRITERIA: Studies including at least 50 patients with COVID-19 in any healthcare setting.

methodsWe used a validated ten-item risk of bias tool for disease prevalence. The main outcome of interest was the proportion of COVID-19 patients with bloodstream and/or respiratory bacterial co-infection and secondary infection. We performed meta-regression to identify study population factors associated with bacterial infection including healthcare setting, age, comorbidities and COVID-19 medication.

resultsOut of 33 345 studies screened, 171 were included in the final analysis. Bacterial infection data were available from 171 262 patients. The prevalence of co-infection was 5.1% (95% CI 3.6-7.1%) and secondary infection was 13.1% (95% CI 9.8-17.2%). There was a higher odds of bacterial infection in studies with a higher proportion of patients in the intensive care unit (ICU) (adjusted OR 18.8, 95% CI 6.5-54.8). Female sex was associated with a lower odds of secondary infection (adjusted OR 0.73, 95% CI 0.55-0.97) but not co-infection (adjusted OR 1.05, 95% CI 0.80-1.37). The most common organisms isolated included Staphylococcus aureus, coagulase-negative staphylococci and Klebsiella species.

conclusionsWhile the odds of respiratory and bloodstream bacterial infection are low in patients with COVID-19, meta-regression revealed potential risk factors for infection, including ICU setting and mechanical ventilation. The risk for secondary infection is substantially greater than the risk for co-infection in patients with COVID-19. Understanding predictors of co-infection and secondary infection may help to support improved antibiotic stewardship in patients with COVID-19.

Indexed as

Antimicrobial StewardshipBacterial InfectionsCOVID-19Respiratory Tract InfectionsBacteriaFemaleHumansAntimicrobial stewardshipBacterial infectionCo-infectionCOVID-19Risk factorsSecondary infection

Identifiers

PMID34843962
PMCPMC8619885
OpenAlexW3216128019

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.