Article ; Online: Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics.
The Journal of antimicrobial chemotherapy
2020 Volume 76, Issue 5, Page(s) 1323–1331
Abstract: ... their response to antibiotic therapy could distinguish bacterial co-infection from COVID-19.: Methods ... that occur in bacterial pulmonary infections, testing the hypothesis that baseline inflammatory markers and ... of both elevated baseline WCC and antibiotic-related decrease in CRP can exclude bacterial co-infection and ...
| Abstract | Background: COVID-19 is infrequently complicated by bacterial co-infection, but antibiotic prescriptions are common. We used community-acquired pneumonia (CAP) as a benchmark to define the processes that occur in bacterial pulmonary infections, testing the hypothesis that baseline inflammatory markers and their response to antibiotic therapy could distinguish bacterial co-infection from COVID-19. Methods: Retrospective cohort study of CAP (lobar consolidation on chest radiograph) and COVID-19 (PCR detection of SARS-CoV-2) patients admitted to Royal Free Hospital (RFH) and Barnet Hospital (BH), serving as independent discovery and validation cohorts. All CAP and >90% COVID-19 patients received antibiotics on hospital admission. Results: We identified 106 CAP and 619 COVID-19 patients at RFH. Compared with COVID-19, CAP was characterized by elevated baseline white cell count (WCC) [median 12.48 (IQR 8.2-15.3) versus 6.78 (IQR 5.2-9.5) ×106 cells/mL, P < 0.0001], C-reactive protein (CRP) [median 133.5 (IQR 65-221) versus 86.0 (IQR 42-160) mg/L, P < 0.0001], and greater reduction in CRP 48-72 h into admission [median ΔCRP -33 (IQR -112 to +3.5) versus +14 (IQR -15.5 to +70.5) mg/L, P < 0.0001]. These observations were recapitulated in the independent validation cohort at BH (169 CAP and 181 COVID-19 patients). A multivariate logistic regression model incorporating WCC and ΔCRP discriminated CAP from COVID-19 with AUC 0.88 (95% CI 0.83-0.94). Baseline WCC >8.2 × 106 cells/mL or falling CRP identified 94% of CAP cases, and excluded bacterial co-infection in 46% of COVID-19 patients. Conclusions: We propose that in COVID-19, absence of both elevated baseline WCC and antibiotic-related decrease in CRP can exclude bacterial co-infection and facilitate antibiotic stewardship efforts. |
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| MeSH term(s) | Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Biomarkers/blood ; C-Reactive Protein/analysis ; COVID-19/complications ; Coinfection/diagnosis ; Community-Acquired Infections/diagnosis ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Leukocyte Count ; Male ; Middle Aged ; Pneumonia, Bacterial/diagnosis ; Retrospective Studies ; Young Adult |
| Chemical Substances | Anti-Bacterial Agents ; Biomarkers ; C-Reactive Protein (9007-41-4) |
| Language | English |
| Publishing date | 2020-09-30 |
| Publishing country | England |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 191709-2 |
| ISSN | 1460-2091 ; 0305-7453 |
| ISSN (online) | 1460-2091 |
| ISSN | 0305-7453 |
| DOI | 10.1093/jac/dkaa563 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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