Recommendations for antibacterial therapy in adults with COVID-19 - an evidence based guideline.

{"article_title":"Recommendations for antibacterial therapy in adults with COVID-19 - an evidence based guideline.","author":"Sieswerda E, de Boer MGJ, Bonten MMJ, Boersma WG, Jonkers RE, Aleva RM, Kullberg BJ, Schouten JA, van de Garde EMW, Verheij TJ, van der Eerden MM, Prins JM, Wiersinga WJ","journal_title":"Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases","issn":"1469-0691","isbn":"","publication_date":"2021-01-01","volume":"27","issue":"1","first_page":"61","page_count":"","accession_number":"33010444","doi":"10.1016\/j.cmi.2020.09.041","publisher":"Elsevier","doctype":"Journal Article","subjects":"Anti-Bacterial Agents therapeutic use; Bacterial Infections drug therapy; Opportunistic Infections drug therapy; Pneumonia, Bacterial drug therapy; SARS-CoV-2 pathogenicity; COVID-19 Drug Treatment; Bacterial Infections diagnosis; Bacterial Infections microbiology; Bacterial Typing Techniques; Bias; Blood Culture methods; COVID-19 microbiology; COVID-19 virology; Coinfection; Evidence-Based Medicine; Humans; Opportunistic Infections diagnosis; Opportunistic Infections microbiology; Pneumonia, Bacterial diagnosis; Pneumonia, Bacterial microbiology; Sputum microbiology","interest_area":["Infectious Disease & Vaccines"," Internal Medicine"],"abstract":"Scope: The Dutch Working Party on Antibiotic Policy constituted a multidisciplinary expert committee to provide evidence-based recommendation for the use of antibacterial therapy in hospitalized adults with a respiratory infection and suspected or proven 2019 Coronavirus disease (COVID-19). Methods: We performed a literature search to answer four key questions. The committee graded the evidence and developed recommendations by using Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions Addressed by the Guideline and Recommendations: We assessed evidence on the risk of bacterial infections in hospitalized COVID-19 patients, the associated bacterial pathogens, how to diagnose bacterial infections and how to treat bacterial infections. Bacterial co-infection upon admission was reported in 3.5% of COVID-19 patients, while bacterial secondary infections during hospitalization occurred up to 15%. No or very low quality evidence was found to answer the other key clinical questions. Although the evidence base on bacterial infections in COVID-19 is currently limited, available evidence supports restrictive antibiotic use from an antibiotic stewardship perspective, especially upon admission. To support restrictive antibiotic use, maximum efforts should be undertaken to obtain sputum and blood culture samples as well as pneumococcal urinary antigen testing. We suggest to stop antibiotics in patients who started antibiotic treatment upon admission when representative cultures as well as urinary antigen tests show no signs of involvement of bacterial pathogens after 48 hours. For patients with secondary bacterial respiratory infection we recommend to follow other guideline recommendations on antibacterial treatment for patients with hospital-acquired and ventilator-associated pneumonia. An antibiotic treatment duration of five days in patients with COVID-19 and suspected bacterial respiratory infection is recommended upon improvement of signs, symptoms and inflammatory markers. Larger, prospective studies about the epidemiology of bacterial infections in COVID-19 are urgently needed to confirm our conclusions and ultimately prevent unnecessary antibiotic use during the COVID-19 pandemic. Copyright \u00a9 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=33010444","isPdfLink":false,"isSAML":true,"an":"33010444","number_other":"","type_pub":"","issn_electronic":"1469-0691","languages":"English","language":"eng","date_entry":"Date Created: 20201003 Date Completed: 20201231 Latest Revision: 20231112","date_update":"20240105","titleSource":"Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2021 Jan; Vol. 27 (1), pp. 61-66. Date of Electronic Publication: 2020 Oct 01.","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2021-01-01","description":"Scope: The Dutch Working Party on Antibiotic Policy constituted a multidisciplinary expert committee to provide evidence-based recommendation for the use of antibacterial therapy in hospitalized adults with a respiratory infection and suspected or proven 2019 Coronavirus disease (COVID-19).<br \/>Methods: We performed a literature search to answer four key questions. The committee graded the evidence and developed recommendations by using Grading of Recommendations Assessment, Development, and Evaluation methodology.<br \/>Questions Addressed by the Guideline and Recommendations: We assessed evidence on the risk of bacterial infections in hospitalized COVID-19 patients, the associated bacterial pathogens, how to diagnose bacterial infections and how to treat bacterial infections. Bacterial co-infection upon admission was reported in 3.5% of COVID-19 patients, while bacterial secondary infections during hospitalization occurred up to 15%. No or very low quality evidence was found to answer the other key clinical questions. Although the evidence base on bacterial infections in COVID-19 is currently limited, available evidence supports restrictive antibiotic use from an antibiotic stewardship perspective, especially upon admission. To support restrictive antibiotic use, maximum efforts should be undertaken to obtain sputum and blood culture samples as well as pneumococcal urinary antigen testing. We suggest to stop antibiotics in patients who started antibiotic treatment upon admission when representative cultures as well as urinary antigen tests show no signs of involvement of bacterial pathogens after 48 hours. For patients with secondary bacterial respiratory infection we recommend to follow other guideline recommendations on antibacterial treatment for patients with hospital-acquired and ventilator-associated pneumonia. An antibiotic treatment duration of five days in patients with COVID-19 and suspected bacterial respiratory infection is recommended upon improvement of signs, symptoms and inflammatory markers. Larger, prospective studies about the epidemiology of bacterial infections in COVID-19 are urgently needed to confirm our conclusions and ultimately prevent unnecessary antibiotic use during the COVID-19 pandemic.<br \/> (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)","upload_link":"https:\/\/go.openathens.net\/redirector\/shalina.com?url=https:\/\/resolver.ebscohost.com\/openurl?sid=EBSCO:mdl&genre=article&issn=14690691&ISBN=&volume=27&issue=1&date=20210101&spage=61&pages=61-66&title=Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases&atitle=Recommendations%20for%20antibacterial%20therapy%20in%20adults%20with%20COVID-19%20-%20an%20evidence%20based%20guideline.&aulast=Sieswerda%20E&id=DOI:10.1016\/j.cmi.2020.09.041&authtype=ip,shib&custid=ns346513&groupid=main&profile=eds","no_of_pages":"","authored_by":"Sieswerda E, de Boer MGJ, Bonten MMJ, Boersma WG, Jonkers RE, Aleva RM, Kullberg BJ, Schouten JA, van de Garde EMW, Verheij TJ, van der Eerden MM, Prins JM, Wiersinga WJ"}