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Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies.

Publication ,  Journal Article
Clancy, CJ; Schwartz, IS; Kula, B; Nguyen, MH
Published in: Open Forum Infect Dis
March 2021

BACKGROUND: Limited clinical data suggest a ~16% prevalence of bacterial superinfections among critically ill patients with coronavirus disease 2019 (COVID-19). METHODS: We reviewed postmortem studies of patients with COVID-19 published in English through September 26, 2020, for histopathologic findings consistent with bacterial lung infections. RESULTS: Worldwide, 621 patients from 75 studies were included. The quality of data was uneven, likely because identifying superinfections was not a major objective in 96% (72/75) of studies. Histopathology consistent with a potential lung superinfection was reported in 32% (200/621) of patients (22-96 years old; 66% men). Types of infections were pneumonia (95%), abscesses or empyema (3.5%), and septic emboli (1.5%). Seventy-three percent of pneumonias were focal rather than diffuse. The predominant histopathologic findings were intra-alveolar neutrophilic infiltrations that were distinct from those typical of COVID-19-associated diffuse alveolar damage. In studies with available data, 79% of patients received antimicrobial treatment; the most common agents were beta-lactam/beta-lactamase inhibitors (48%), macrolides (16%), cephalosoprins (12%), and carbapenems (6%). Superinfections were proven by direct visualization or recovery of bacteria in 25.5% (51/200) of potential cases and 8% of all patients in postmortem studies. In rank order, pathogens included Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Lung superinfections were the cause of death in 16% of potential cases and 3% of all patients with COVID-19. CONCLUSIONS: Potential bacterial lung superinfections were evident at postmortem examination in 32% of persons who died with COVID-19 (proven, 8%; possible, 24%), but they were uncommonly the cause of death.

Duke Scholars

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Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

March 2021

Volume

8

Issue

3

Start / End Page

ofab065

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Clancy, C. J., Schwartz, I. S., Kula, B., & Nguyen, M. H. (2021). Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies. Open Forum Infect Dis, 8(3), ofab065. https://doi.org/10.1093/ofid/ofab065
Clancy, Cornelius J., Ilan S. Schwartz, Brittany Kula, and M Hong Nguyen. “Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies.Open Forum Infect Dis 8, no. 3 (March 2021): ofab065. https://doi.org/10.1093/ofid/ofab065.
Clancy CJ, Schwartz IS, Kula B, Nguyen MH. Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies. Open Forum Infect Dis. 2021 Mar;8(3):ofab065.
Clancy, Cornelius J., et al. “Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies.Open Forum Infect Dis, vol. 8, no. 3, Mar. 2021, p. ofab065. Pubmed, doi:10.1093/ofid/ofab065.
Clancy CJ, Schwartz IS, Kula B, Nguyen MH. Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies. Open Forum Infect Dis. 2021 Mar;8(3):ofab065.
Journal cover image

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

March 2021

Volume

8

Issue

3

Start / End Page

ofab065

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences