Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis


Background: Bacterial co-pathogens are commonly identified in viral respiratory infections and are an important cause of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood. Objective: To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19. Data Sources: We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16 2020. Study Eligibility Criteria: Studies were included if they 1) evaluated patients with confirmed COVID-19 and 2) reported the prevalence of acute bacterial infection. Methods: Data were extracted by a single reviewer and cross-checked by a second reviewer. The main outcome was the proportion of COVID-19 patients with an acute bacterial infection. Any bacteria detected from non-respiratory tract or non-bloodstream source were excluded. Results: Of 1308 studies screened, 28 were eligible and included in the rapid review representing 3448 patients with COVID-19 evaluated for acute bacterial infection. In the meta-analysis, bacterial co-infection (estimated on presentation) was identified in 3.5% of patients (95%CI 0.6 to 6.5%) and secondary bacterial infection in 15.5% of patients (95%CI 10.9 to 20.1%). The overall proportion of COVID-19 patients with bacterial infection was 7.1% (95%CI 4.6 to 9.6%). Bacterial infection was more common in critically ill patients 8.1% (95%CI 2.3 to 13.8). The majority of patients with COVID-19 received antibiotics (71.3%, 95%CI 57.1 to 85.5%). Conclusions: Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empiric antibacterial treatment. PROSPERO Registration CRD42020180229.

Clinical Microbiology and Infection (in press)