PMC:7195088 / 53049-56136 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7195088","sourcedb":"PMC","sourceid":"7195088","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7195088","text":"Question 4. should antibiotics be administered?\nBacterial infections can present simultaneously with COVID-19 or occur later during the course of the disease, worsening clinical conditions of patients who were recovering from primary viral pneumonia. Information regarding the prevalence of bacterial coinfection or superinfection is scant [28,44,45]. According to the available reports, prevalence of bacterial infections in patients with COVID-19 ranges between 1% and 10% [28,44,46]. In these reports, bacterial infections were due to Gram-negative bacteria including Enterobacterales and nonfermenting rods [28,44]. It is of note that up to 98% of COVID-19 patients in available experiences received intravenous broad-spectrum empirical antibiotics [28,44,45,47], probably reflecting the frequent inability to exclude the presence of bacterial coinfection at the onset of severe clinical presentations of COVID-19. This could have possibly lowered the overall prevalence of bacterial superinfections.\nExtrapolating data from experiences on bacterial superinfection in pneumonia due to other viruses in a retrospective case series of critically ill patients with MERS in Saudi Arabia, bacterial infection was registered in 18% of patients [48]. With similar prevalence, bacterial pneumonia occurred in about 20% of patients hospitalized for primary influenza virus infection [49,50]. In these studies, mortality related to influenza was mostly due to secondary bacterial pneumonia [49,50]. Common bacteria implicated were Staphylococcus aureus, including methicillin-resistant strains [51], Streptococcus pneumoniae, Haemophilus influenzae and group A streptococci [49,52,53].\nThere are currently no large data regarding any possible favourable effects in COVID-19 patients related to possible anti-inflammatory or antiviral effect of azithromycin. Furthermore, the small experiences of the administration of azithromycin in COVID-19 patients have provided conflicting results.\n\nQuestion 4 statement\nIn our opinion, it might be prudent to consider empiric antibiotic treatment in critically ill patients with pneumonia due to COVID-19 in whom bacterial infection cannot be excluded. This suggestion is based on the facts that bacterial coinfection is common in patients with viral pneumonia and that it can be associated with a substantial risk of delaying appropriate treatment, thereby potentially increasing mortality. Because of the limited available data on both the microbiologic epidemiology (and the prevalence of antimicrobial resistance) of bacterial superinfections in COVID-19 patients, it is difficult to provide specific pathogen-oriented recommendations. Therefore, pending further studies, we suggest to empirically treat COVID-19 patients according to their clinical syndrome (e.g. community-acquired pneumonia, hospital-acquired pneumonia), choosing the best antimicrobial agent or agents on the basis of local guidelines and local antibiotic susceptibility patterns, with early de-escalation or discontinuation according to microbiology results, whenever 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