Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis

• Published in: PloS one Vol. 17; no. 8; p. e0272375
• Main Authors: Alshaikh, Faisal Salman, Godman, Brian, Sindi, Oula Nawaf, Seaton, R Andrew, Kurdi, Amanj
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.08.2022; Public Library of Science (PLoS)
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial resistance; Bacteria; Bacterial infections; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Biology and Life Sciences; Coinfection - drug therapy; Coinfection - epidemiology; Coinfection - microbiology; Complications and side effects; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 Drug Treatment; Diagnosis; Humans; Infections; Medicine and Health Sciences; Meta-analysis; Mortality; Pandemics; Patients; People and Places; Physical Sciences; Prevalence; Research and Analysis Methods; Risk factors; Systematic review; Viral diseases; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0272375

Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR). To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients. OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting. Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design. A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26-10.31) and 61.77% (CI 50.95-70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30-14.18). Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.