The widespread use of antibiotics in patients with COVID-19 is raising concerns due to the risk of accelerated spread of antibiotic resistance. In Ukraine, antibiotic consumption increased 40-fold in 2020 (Chief Sanitary Doctor Viktor Lyashko announced this information at a meeting of the Verkhovna Rada). The question is: is such extensive use of antimicrobials justified? Are bacterial coinfections and secondary infections truly common in patients with COVID-19? The authors of a meta-analysis of 24 clinical studies, which included a total of 3,338 patients with laboratory-confirmed COVID-19*, sought to answer this question.

The researchers analyzed patient data for acute bacterial infections, excluding infections localized outside the respiratory tract and bloodstream. Bacterial coinfections (present from the onset of illness) were found in 3.5% of patients, and secondary bacterial infections (developing some time after illness onset) were found in 14.3%. Overall, the proportion of COVID-19 patients with bacterial infections was 6.9%. Antibiotics were administered to 71.9% of patients.

The authors of the meta-analysis note that bacterial coinfections are relatively rare among patients with COVID-19 and believe that these rates are insufficient to warrant widespread empirical antibiotic prescription, especially for patients who are not critically ill.

* Langford BJ, So M, Raybardhan S, Leung V et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020 Dec;26(12):1622-1629. doi: 10.1016/j.cmi.2020.07.016 .