Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics

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 inflammato...

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Bibliographic Details
Published in:Journal of Antimicrobial Chemotherapy 2021-04, Vol.76 (5), p.1323-1331
Main Authors: Mason, Claire Y, Kanitkar, Tanmay, Richardson, Charlotte J, Lanzman, Marisa, Stone, Zak, Mahungu, Tabitha, Mack, Damien, Wey, Emmanuel Q, Lamb, Lucy, Balakrishnan, Indran, Pollara, Gabriele
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Biomarkers - blood
C-Reactive Protein - analysis
Coinfection - diagnosis
Community-Acquired Infections - diagnosis
COVID-19 - complications
Diagnosis, Differential
Female
Humans
Inflammation
Leukocyte Count
Male
Middle Aged
Original Research
Pneumonia, Bacterial - diagnosis
Retrospective Studies
Young Adult
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Summary: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 
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkaa563