Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis.
Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis.
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DOI：
10.1016/j.cmi.2020.07.016
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Daneman N
中科院分区：
文献类型：
--
作者：
Langford BJ;So M;Raybardhan S;Leung V;Westwood D;MacFadden DR;Soucy JR;Daneman N
细菌共病原体通常在病毒性呼吸道感染中被鉴定，并且是发病率和死亡率的重要原因。感染SARS-CoV-2的患者中细菌感染的患病率尚不清楚。确定COVID-19患者中细菌合并感染（就诊时）和继发感染（就诊后）的患病率。我们对MEDLINE、奥维德Epub和EMBASE数据库进行了2019年至2020年4月16日的英文文献系统检索。如果研究（a）评估了确诊COVID-19的患者，（B）报告了急性细菌感染的患病率，则纳入研究。由一名审查员提取数据，并由第二名审查员交叉检查。主要结果是COVID-19患者发生急性细菌感染的比例。排除从非呼吸道或非血流来源检测到的任何细菌。在筛选的1308项研究中，有24项符合条件并被纳入快速审查，代表3338名接受急性细菌感染评估的COVID-19患者。在荟萃分析中，3.5%的患者（95%CI 0.4-6.7%）确定了细菌合并感染（根据就诊情况估计），14.3%的患者（95%CI 9.6-18.9%）确定了继发性细菌感染。COVID-19患者中细菌感染的总体比例为6.9%（95%CI 4.3-9.5%）。细菌感染在危重患者中更常见（8.1%，95%CI 2.3-13.8%）。大多数COVID-19患者接受了抗生素治疗（71.9%，95%CI 56.1至87.7%）。在COVID-19住院患者中，细菌合并感染相对罕见。这些患者中的大多数可能不需要经验性抗菌治疗。
Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood. To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19. We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020. Studies were included if they (a) evaluated patients with confirmed COVID-19 and (b) reported the prevalence of acute bacterial infection. 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 sources were excluded. Of 1308 studies screened, 24 were eligible and included in the rapid review representing 3338 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 0.4–6.7%) and secondary bacterial infection in 14.3% of patients (95%CI 9.6–18.9%). The overall proportion of COVID-19 patients with bacterial infection was 6.9% (95%CI 4.3–9.5%). Bacterial infection was more common in critically ill patients (8.1%, 95%CI 2.3–13.8%). The majority of patients with COVID-19 received antibiotics (71.9%, 95%CI 56.1 to 87.7%). Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.
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