Publication Date
3-1-2023
Journal
Open Forum Infectious Diseases
DOI
10.1093/ofid/ofad122
PMID
36968962
PMCID
ID: PMC10034750
PubMedCentral® Posted Date
3-6-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
antimicrobial stewardship, bacterial coinfection, pediatric COVID-19, pneumonia, SARS-CoV-2
Abstract
BACKGROUND: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.
METHODS: We evaluated children and adolescents agedadmission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.
RESULTS: Of the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01-1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05-1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36-2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15-4.62]) was associated with bacterial coinfection.
CONCLUSIONS: Community-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely.
Included in
Clinical Epidemiology Commons, Community Health and Preventive Medicine Commons, COVID-19 Commons, Critical Care Commons, Epidemiology Commons, Medical Sciences Commons, Pediatrics Commons
