JMM Editor’s Choice: COVID-19 co-infection in the critically ill

Posted on July 15, 2021   by Microbiology Society

In this blog, Professor Kim Hardie discusses “Co-infection in critically ill patients with COVID-19: an observational cohort study from England”, which was chosen as Editor’s Choice for the Journal of Medical Microbiology after it's publication in April.

This retrospective study, of a sizable patient population of 254 individuals, is interesting because it assessed the bacterial co-infections associated with COVID-19 admissions across 19 intensive care units. The study found a high rate of Gram-negative infections acquired during stays in intensive care. This finding will be useful to inform future care regimens to save lives. Reducing unnecessary early antibiotic exposure in patients with COVID-19 could reduce their risk of late, Gram-negative, potentially antimicrobial resistant (AMR) infections, and emphasises the need for ongoing surveillance for co-infections in hospitalised patients to limit rises in AMR.

Co-infection in critically ill patients with COVID-19: an observational cohort study from England

In previous viral pandemics, a large proportion of severe illness and death was complicated by concurrent bacterial infection. We performed this study to develop a better understanding of the occurrence of co-infection in critically ill adults with COVID-19 infection in England. We found that bacterial co-infection was uncommon early on during hospitalisation. Our findings support the recommendation that antibiotics should not be routinely used in primary care or at the point of admission unless a bacterial infection is clinically suspected.

We spoke with Dr Vadsala Baskaran & Dr Hannah Lawrence to find out more:

What is your institution and how long have you been there?

University of Nottingham & Nottingham University Hospitals NHS Trust. We have been here as Clinical Research Fellows for about four years, and as Specialist Trainees in Respiratory Medicine in the East Midlands region, prior to commencing our PhDs.

What is your research area?
V: Morbidity of community-acquired pneumonia

H: Acute respiratory infections

What inspired you to research this topic?

There was  wide use of antibiotics during the spring wave of the COVID-19 pandemic in 2020. Incorrect use of antibiotics could contribute to antimicrobial resistance. Hence it was crucial to describe the occurrence and nature of co-infection, in order to understand the appropriateness of antibiotic prescription for patients admitted with COVID-19 infection.

What is the most rewarding part of your research?

The most rewarding part is when our study findings directly contribute to the development of national guidelines. For example, recently our work informed the NICE COVID-19 rapid guideline: Managing COVID-19, which was done in a very short timeframe, contrary to usual practice. 

Follow the authors on Twitter:

Vadsala Baskaran, Hannah Lawrence, Karmel Webb, Shahideh Safavi, Bethan Charles, Sara Boyd, Jamie McCanny, Jonathan Edgeworth, Martin Llewelyn, Matthias Schmid and British Infection Association