The Unrecognized #Threat of Secondary #Bacterial #Infections with #COVID19 (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

The Unrecognized Threat of Secondary Bacterial Infections with COVID-19

Mylene Vaillancourt, Peter Jorth

DOI: 10.1128/mBio.01806-20



Coronavirus disease 2019 (COVID-19) is the greatest pandemic of our generation, with 16 million people affected and 650,000 deaths worldwide so far. One of the risk factors associated with COVID-19 is secondary bacterial pneumonia. In recent studies on COVID-19 patients, secondary bacterial infections were significantly associated with worse outcomes and death despite antimicrobial therapies. In the past, the intensive use of antibiotics during the severe acute respiratory syndrome coronavirus (SARS-CoV) pandemic led to increases in the prevalence of multidrug-resistant bacteria. The rising number of antibiotic-resistant bacteria and our decreasing capacity to eradicate them not only render us more vulnerable to bacterial infections but also weaken us during viral pandemics. The COVID-19 pandemic reminds us of the great health challenges we are facing, especially regarding antibiotic-resistant bacteria.

The views expressed in this article do not necessarily reflect the views of the journal or of ASM.

Keywords: SARS-CoV-2; COVID-19; Bacterial coinfections; Antibiotics; Drugs Resistance.


#Antibiotic use in patients with #COVID19: a ‘snapshot’ Infectious Diseases International Research Initiative (ID-IRI) survey (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Antibiotic use in patients with COVID-19: a ‘snapshot’ Infectious Diseases International Research Initiative (ID-IRI) survey

Bojana Beović, May Doušak, João Ferreira-Coimbra, Kristina Nadrah, Francesca Rubulotta, Mirko Belliato, Joana Berger-Estilita, Folusakin Ayoade, Jordi Rello, Hakan Erdem

Journal of Antimicrobial Chemotherapy, dkaa326,

Published: 07 August 2020




Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection.


To investigate antibiotic prescribing practices in patients with COVID-19.


We performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis.


The survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of β-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days.


The study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.


Keywords: SARS-CoV-2; COVID-19; Antibiotics.


Early #Outpatient #Treatment of Symptomatic, High-Risk #Covid19 Patients (Am J Epidemiol., summary)

[Source: American Journal of Epidemiology, full page: (LINK). Summary, edited.]

Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients

Tony M. Korman MBBS FRACP FRCPA, Adjunct Clinical Professor, Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Director, Monash Infectious Diseases, Monash Health, Director, Microbiology, Monash Pathology, 246 Clayton Road, Clayton VIC 3168, Australia – T: +61 3 9594 4564 – F: +61 3 9594 4533 – E:

Conflict of Interest: In the last two years T.K. received conference attendance  sponsorship and was a speaker at a congress sponsored by Pfizer and was a chairman at  a meeting organised by Gilead (with no personal payment) unrelated to this work.


© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns  Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please  e‐mail:

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Risch makes an impassioned plea that we are “unable to wait for results of randomized controlled trials” for COVID-19 and should “immediately roll out” early outpatient treatment with hydroxychloroquine (HCQ) and azithromycin (AZ).1 Early treatment that  prevents disease progression and hospitalization is desperately needed, and timing of  initiation of antiviral therapy may have important effects on the outcomes of therapy for  COVID-19.2 Unfortunately, “based on laboratory and other preliminary evidence to-date”,  no treatment is available “effective in preventing hospitalization for the  overwhelming majority”, and there are potential hazards associated with HCQ+AZ.


Keywords: SARS-CoV-2; COVID-19; Antivirals; Antibiotics; Chloroquine; Azithromycin.


#Coinfections in #COVID19 critically ill and #antibiotic #management: a prospective cohort analysis (Crit Care, summary)

[Source: Critical Care, full page: (LINK). Summary, edited.]

Co-infections in COVID-19 critically ill and antibiotic management: a prospective cohort analysis

Alexia Verroken, Anaïs Scohy, Ludovic Gérard, Xavier Wittebole, Christine Collienne & Pierre-François Laterre

Critical Care volume 24, Article number: 410 (2020)


International guidelines recommend the initiation of empirical antibiotherapy for possible associated bacterial pneumonia in COVID-19 critically ill yet further suggesting a rapid reassessment upon source documentation [1]. In this prospective cohort analysis, we investigated the respiratory co-infection rate in COVID-19 critically ill through the use of rapid molecular testing and measured its impact on antibiotic management.


Keywords: SARS-CoV-2; COVID-19; Intensive Care; Antibiotics.


#COVID19 and #Antimicrobial #Resistance: Parallel and Interacting #Health #Emergencies (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

COVID-19 and Antimicrobial Resistance: Parallel and Interacting Health Emergencies

Robby Nieuwlaat, Lawrence Mbuagbaw, Dominik Mertz, Lori Burrows, Dawn M E Bowdish, Lorenzo Moja, Gerry D Wright, Holger J Schünemann

Clinical Infectious Diseases, ciaa773,

Published: 16 June 2020



The COVID-19 pandemic and antimicrobial resistance are parallel and interacting health emergencies with opportunity for mutual learning. As their measures and consequences are comparable, the COVID-19 pandemic helps to illustrate the potential long-term impact of AMR, which is less acute but not less crucial. They may also impact each other as there is a push to resort to existing antimicrobials in critically ill COVID-19 patients in the absence of specific treatments, while attempts to manage the spread of COVID-19 may also lead to a slow down AMR. Understanding how COVID-19 affects AMR trends and what we can expect if these remain the same or worsen, will help us plan next steps to tackle AMR. Researchers should now start collecting data to measure the impact of current COVID-19 policies and programs on AMR.

COVID-19, SARS-CoV-2, antimicrobial resistance, antibiotic resistance

Issue Section: Viewpoints

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Keywords: SARS-CoV-2; COVID-19; Antibiotics; Drugs Resistance.


#Hydroxychloroquine or #chloroquine with or without a #macrolide for #treatment of #COVID19: a multinational registry analysis (Lancet, abstract)

[Source: Lancet, full page: (LINK). Abstract, edited.]

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

Prof Mandeep R Mehra, MD, Sapan S Desai, MD, Prof Frank Ruschitzka, MD, Amit N Patel, MD

Published: May 22, 2020 | DOI:




Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.


We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).


96 032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14 888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81 144 patients were in the control group. 10 698 (11·1%) patients died in hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.


We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.


William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women’s Hospital.

Keywords: SARS-CoV-2; COVID-19; Antivirals; Chloroquine; Drugs safety; Macrolides; Antibiotics.


#Treatment of #CAP During the #Coronavirus Disease 2019 (#COVID19) Pandemic (Ann Intern Med., summary)

[Source: Annals of Internal Medicine, full page: (LINK). Summary, edited.]

Treatment of Community-Acquired Pneumonia During the Coronavirus Disease 2019 (COVID-19) Pandemic

Joshua P. Metlay, MD, PhD; Grant W. Waterer, MB, BS, PhD


The rapidly escalating coronavirus disease 2019 (COVID-19) pandemic has focused attention on the diagnosis and treatment of patients with acute respiratory infection in an unprecedented manner. Although most of the lung injury patients have is believed to be caused by the virus, concern over bacterial co-infection also informs current treatment approaches for patients with COVID-19–related pneumonia. As the cochairs of the recently released American Thoracic Society and Infectious Diseases Society of America Guideline for Treatment of Adults with Community-Acquired Pneumonia (CAP) (1), we offer our interpretation of the guideline as it applies to the management of patients with COVID-19 (Table).


Keywords: SARS-CoV-2; COVID-19; CAP; Antibiotics.


#Bacterial and #fungal #coinfection in individuals with #coronavirus: A rapid review to support #COVID19 #antimicrobial prescribing (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing

Timothy M Rawson, Luke S P Moore, Nina Zhu, Nishanthy Ranganathan, Keira Skolimowska, Mark Gilchrist, Giovanni Satta, Graham Cooke, Alison Holmes

Clinical Infectious Diseases, ciaa530,

Published: 02 May 2020




To explore and describe the current literature surrounding bacterial/fungal co-infection in patients with coronavirus infection.


MEDLINE, EMBASE, and Web of Science were searched using broad based search criteria relating to coronavirus and bacterial co-infection. Articles presenting clinical data for patients with coronavirus infection (defined as SARS-1, MERS, SARS-COV-2, and other coronavirus) and bacterial/fungal co-infection reported in English, Mandarin, or Italian were included. Data describing bacterial/fungal co-infections, treatments, and outcomes were extracted. Secondary analysis of studies reporting antimicrobial prescribing in SARS-COV-2 even in the absence of co-infection was performed.


1007 abstracts were identified. Eighteen full texts reported bacterial/fungal co-infection were included. Most studies did not identify or report bacterial/fungal coinfection (85/140;61%). 9/18 (50%) studies reported on COVID-19, 5/18 (28%) SARS-1, 1/18 (6%) MERS, and 3/18 (17%) other coronavirus.

For COVID-19, 62/806 (8%) patients were reported as experiencing bacterial/fungal co-infection during hospital admission. Secondary analysis demonstrated wide use of broad-spectrum antibacterials, despite a paucity of evidence for bacterial coinfection. On secondary analysis, 1450/2010 (72%) of patients reported received antimicrobial therapy. No antimicrobial stewardship interventions were described.

For non-COVID-19 cases bacterial/fungal co-infection was reported in 89/815 (11%) of patients. Broad-spectrum antibiotic use was reported.


Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal co-infection. Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic are urgently required.

SARS-COV-2, antimicrobial stewardship, antimicrobial resistance

Issue Section: Major Article

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© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (

Keywords: SARS-CoV-2; COVID-19; Antibiotics.


#PVL–Secreting #Staphylococcus aureus #Pneumonia Complicating #COVID19 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases, full page: (LINK). Abstract, edited.]

Volume 26, Number 8—August 2020 | Research Letter

Panton-Valentine Leukocidin–Secreting Staphylococcus aureus Pneumonia Complicating COVID-19

Claire Duployez  , Rémi Le Guern, Claire Tinez, Anne-Laure Lejeune, Laurent Robriquet, Sophie Six, Caroline Loïez, and Frédéric Wallet

Author affiliations: Centre Hospitalier Universitaire Lille, Lille, France (C. Duployez, R. Le Guern, C. Tinez, A.-L. Lejeune, L. Robriquet, S. Six, C. Loïez, F. Wallet); University of Lille (C. Duployez, R. Le Guern, A.-L. Lejeune)



Necrotizing pneumonia induced by Panton-Valentine leukocidin–secreting Staphylococcus aureus is a rare but life-threatening infection that has been described in patients after they had influenza. We report a fatal case of this superinfection in a young adult who had coronavirus disease.

Keywords: SARS-CoV-2; COVID-19; Antibiotics; Drugs Resistance; Staphylococcus aureus; Necrotizing pneumonia.


#Hydroxychloroquine and #azithromycin as a #treatment of #COVID19: results of an openlabel non-randomized clinical trial (Int J Antimicrob Agents., abstract)

[Source:  , full page: (LINK). Abstract, edited. Via Virology Blog, ]

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial

Philippe Gautret a,b$, Jean-Christophe Lagier a,c$, Philippe Parola a,b, Van Thuan Hoang a,b,d, Line Meddeb a, Morgane Mailhe a, Barbara Doudier a, Johan Courjon e,f,g, Valérie Giordanengo h, Vera Esteves Vieira a, Hervé Tissot Dupont a,c, Stéphane Honoré i,j, Philippe Colson a,c, Eric Chabrière a,c, Bernard La Scola a,c, Jean-Marc Rolain a,c, Philippe Brouqui a,c, Didier Raoult a,c*.

{a} IHU-Méditerranée Infection, Marseille, France. {b} Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France. {c} Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France. {d} Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam; {e} Infectiologie, Hôpital de l’Archet, Centre Hospitalier Universitaire de Nice, Nice, France; {f} Université Côte d’Azur, Nice, France; {g} U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Virulence Microbienne et Signalisation Inflammatoire, INSERM, Nice, France; {h} Department of Virology, Biological and Pathological Center, Centre Hospitalier Universitaire de Nice, 06200 Nice, France. {i} Service Pharmacie, Hôpital Timone, AP-HM, Marseille, France; {j} Laboratoire de Pharmacie Clinique, Aix Marseille Université, Marseille, France.

{$} equal work

{*} Corresponding author

Please cite this work as Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of  COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of  Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949

Didier Raoult




Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads.

Patients and methods

French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point.


Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.


Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.

Key words: 2019-nCoV; SARS-CoV-2; COVID-19; hydroxychloroquine; azithomycin; clinical trial

Keywords: SARS-CoV-2; COVID-19; Antivirals; Antibiotics; Azithromycin; Hydroxychloroquine.