Evidence map›Paper›PMID 36736332›Full record

SynthesisThe Lancet. Microbe2023

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis.

Bradley J Langford, Miranda So, Marina Simeonova, Valerie Leung, Jennifer Lo, Tiffany Kan, Sumit Raybardhan, Mia E Sapin, Kwadwo Mponponsuo, Ashley Farrell and 6 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Microbe, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 113 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
113citing papers in PubMed, 3 pooled it
28.4field-weighted citation impact, top 1% 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

113 citing papers in PubMed, 3 syntheses or guidelines pooled it, 157 citations in OpenAlex.

  1. Pooled it
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  3. 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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53 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 8 institutions in 1 country.

Bradley J LangfordPublic Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: bradley.langford@oahpp.ca.
Miranda SoLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada.
Marina SimeonovaSunnybrook Health Sciences Centre, Toronto, ON, Canada.
Valerie LeungPublic Health Ontario, Toronto, ON, Canada; Toronto East Health Network, Toronto, ON, Canada.
Jennifer LoSunnybrook Health Sciences Centre, Toronto, ON, Canada.
Tiffany KanNorth York General Hospital, Toronto, ON, Canada.
Sumit RaybardhanNorth York General Hospital, Toronto, ON, Canada.
Mia E SapinSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Kwadwo MponponsuoUniversity of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada.
Ashley FarrellUniversity Health Network, Toronto, ON, Canada.
Elizabeth LeungLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, UK.
Jean-Paul R SoucyDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Alessandro CassiniAntimicrobial Resistance Division, WHO, Geneva, Switzerland.
Derek MacFaddenSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada.
Nick DanemanPublic Health Ontario, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Silvia BertagnolioAntimicrobial Resistance Division, WHO, Geneva, Switzerland.
University of Toronto · CANorth York General Hospital · CASunnybrook Health Science Centre · CAUniversity Health Network · CAUniversity of Ottawa · CAAlberta Health Services · CAHealth Sciences Centre · CAPublic Health Ontario · CA

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundFrequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed to establish the prevalence and predictors of bacterial infections and antimicrobial resistance in patients with COVID-19.

methodsWe did a systematic review and meta-analysis of studies of bacterial co-infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalised patients with COVID-19. We searched the WHO COVID-19 Research Database to identify cohort studies, case series, case-control trials, and randomised controlled trials with populations of at least 50 patients published in any language between Jan 1, 2019, and Dec 1, 2021. Reviews, editorials, letters, pre-prints, and conference proceedings were excluded, as were studies in which bacterial infection was not microbiologically confirmed (or confirmed via nasopharyngeal swab only). We screened titles and abstracts of papers identified by our search, and then assessed the full text of potentially relevant articles. We reported the pooled prevalence of bacterial infections and antimicrobial resistance by doing a random-effects meta-analysis and meta-regression. Our primary outcomes were the prevalence of bacterial co-infection and secondary infection, and the prevalence of antibiotic-resistant pathogens among patients with laboratory-confirmed COVID-19 and bacterial infections. The study protocol was registered with PROSPERO (CRD42021297344).

findingsWe included 148 studies of 362  976 patients, which were done between December, 2019, and May, 2021. The prevalence of bacterial co-infection was 5·3% (95% CI 3·8-7·4), whereas the prevalence of secondary bacterial infection was 18·4% (14·0-23·7). 42 (28%) studies included comprehensive data for the prevalence of antimicrobial resistance among bacterial infections. Among people with bacterial infections, the proportion of infections that were resistant to antimicrobials was 60·8% (95% CI 38·6-79·3), and the proportion of isolates that were resistant was 37·5% (26·9-49·5). Heterogeneity in the reported prevalence of antimicrobial resistance in organisms was substantial (I

interpretationAlthough infrequently assessed, antimicrobial resistance is highly prevalent in patients with COVID-19 and bacterial infections. Future research and surveillance assessing the effect of COVID-19 on antimicrobial resistance at the patient and population level are urgently needed.

fundingWHO.

Indexed as

Bacterial InfectionsCoinfectionCOVID-19Anti-Bacterial AgentsDrug Resistance, BacterialHumansAnti-Bacterial Agents

Identifiers

PMID36736332
PMCPMC9889096
OpenAlexW4318677392

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.