Using risk factors and markers to predict bacterial respiratory co-/superinfections in COVID-19 patients: is the antibiotic steward’s toolbox full or empty?

ABSTRACT

Background

Adequate diagnosis of bacterial respiratory tract co-/superinfection (bRTI) in coronavirus disease (COVID-19) patients is challenging, as there is insufficient knowledge about the role of risk factors and (para)clinical parameters in the identification of bacterial co-/superinfection in the COVID-19 setting. Empirical antibiotic therapy is mainly based on COVID-19 severity and expert opinion, rather than on scientific evidence generated since the start of the pandemic.

Purpose

We report the best available evidence regarding the predictive value of risk factors and (para)clinical markers in the diagnosis of bRTI in COVID-19 patients.

Methods

A multidisciplinary team identified different potential risk factors and (para)clinical predictors of bRTI in COVID-19 and formulated one or two research questions per topic. After a thorough literature search, research gaps were identified, and suggestions concerning further research were formulated. The quality of this narrative review was ensured by following the Scale for the Assessment of Narrative Review Articles.

Results

Taking into account the scarcity of scientific evidence for markers and risk factors of bRTI in COVID-19 patients, to date, COVID-19 severity is the only parameter which can be associated with higher risk of developing bRTI.

Conclusions

Evidence on the usefulness of risk factors and (para)clinical factors as predictors of bRTI in COVID-19 patients is scarce. Robust studies are needed to optimise antibiotic prescribing and stewardship activities in the context of COVID-19.

KEYWORDS:

• Bacterial respiratory tract infection
• COVID-19
• co-infection
• superinfection
• antimicrobial stewardship

Disclosure statement

J. Van Laethem, J. Pierreux, S.C.M. Wuyts, D. De Geyter, SD. Allard and Nicolas Dauby declare they have no conflicts of interest.

Authors’ contributions

J. Van Laethem and J. Pierreux are both first authors and equally shared the workload: study concept, study design, data collection, data analysis and interpretation, and writing and revision. S.C.M. Wuyts, D. De Geyter, Nicolas Dauby: data collection, data analysis and interpretation, and writing and revision. SD. Allard: study concept, study design, and revision.

Data availability statement

All supplementary data collected during this review process can be found in the section ‘Supplementary Materials’. Further information concerning the datasets can be inquired by emailing the first author (contact person).

Ethics approval

As this is a narrative review, none was needed.

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17843286.2023.2167328

Transparency declaration

N. Dauby is a post-doctorate clinical master specialist of the Belgian F.R.S-FNRS and reports personal fees from Roche and Boehringer-Ingelheim, and non-financial support from Pfizer, Janssen, and Merck Sharp & Dohme, all outside the submitted work. All other authors: none to declare.

Additional information

Funding

None for this work. N. Dauby reports personal fees from Roche and Boehringer-Ingelheim, all outside the submitted work