• Kathrin Rothe, Susanne Feihl, Jochen Schneider, Fabian Wallnöfer, Milena Wurst, Marina Lukas, Matthias Treiber, Tobias Lahmer, Markus Heim, Michael Dommasch, Birgit Waschulzik, Alexander Zink, Christiane Querbach, Dirk H Busch, Roland M Schmid, Gerhard Schneider, and Christoph D Spinner.
• Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Trogerstr. 30, 81675, Munich, Germany. kathrin.rothe@tum.de.
• Eur. J. Clin. Microbiol. Infect. Dis. 2021 Apr 1; 40 (4): 859-869.

AbstractThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17-99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1-13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.

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