Replies

“ Bacterial Pneumonia is different than Viral Pneumonia.

Bacterial Pneumonia is NOT Covid.”
—————————————————————————————————————————-

You are correct, Bacterial Pneumonia and Viral Pneumonia are different.

Covid-19 is known for serious cases of Bacterial Pneumonia.

New England Journal of Medicine:
https://www.jwatch.org/na54035/2021/09/10/identifying-bacterial-pneumonia-patients-with-severe-covid

“ Identifying Bacterial Pneumonia in Patients with Severe COVID-19

Neil M. Ampel, MD, reviewing Pickens CO et al. Am J Respir Crit Care Med 2021 Aug 19

Tests of bronchoalveolar lavage samples from intubated patients showed that only one fifth had evidence of an early bacterial infection and fewer than half developed ventilator-associated pneumonia.

Although the incidence of bacterial superinfection together with SARS-CoV-2 pneumonia is unknown, most patients with severe COVID-19 receive empiric antibacterial therapy. In this single-center retrospective observational study of 179 hospitalized patients with COVID-19 who required mechanical ventilation, researchers evaluated the role of bronchoalveolar lavage (BAL) plus molecular diagnostics for identifying bacterial superinfection (defined as detection of a respiratory pathogen by quantitative culture or multiplex PCR).

BAL was performed within 48 hours of intubation in 133 patients, 28 of whom had documented bacterial superinfection pneumonia. Streptococcus species or methicillin-susceptible Staphylococcus aureus were found in 22 of the 28 cases (79%), consistent with community acquisition. In the 162 patients who remained intubated for >48 hours, another BAL was performed. At least one episode of ventilator-associated pneumonia (VAP) was diagnosed in 72 (44%) of these patients, 15 of whom had a second VAP episode. Early VAP cases were associated with organisms susceptible to narrow-spectrum antibiotics.

COMMENT
These data indicate that early bacterial pneumonia occurs in about one fifth of patients with severe COVID-19 pneumonia and that subsequent VAP occurs in fewer than 50%. While the results endorse obtaining a BAL with PCR and quantitative culture in intubated patients to ascertain whether a bacterial infection is present and to help guide antimicrobial therapy, this tactic may not be reliable and could be costly. A narrower approach, such as obtaining samples in those patients who clinically deteriorate, might be more helpful.”

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

National Library of Medicine
National Center for Biotechnology Information, U.K.:

https://pubmed.ncbi.nlm.nih.gov/33393065/

“ Abstract

Severe 2019 novel coronavirus infectious disease (COVID-19) with pneumonia is associated with high rates of admission to the intensive care unit (ICU). Bacterial coinfection has been reported to be rare. We aimed at describing the rate of bacterial coinfection in critically ill adult patients with severe COVID-19 pneumonia. All the patients with laboratory-confirmed severe COVID-19 pneumonia admitted to the ICU of Tenon University-teaching hospital, from February 22 to May 7th, 2020 were included. Respiratory tract specimens were obtained within the first 48 h of ICU admission. During the study period, 101 patients were referred to the ICU for COVID-19 with severe pneumonia. Most patients (n = 83; 82.2%) were intubated and mechanically ventilated on ICU admission. Overall, 20 (19.8%) respiratory tract specimens obtained within the first 48 h. Staphylococcus aureus was the main pathogen identified, accounting for almost half of the early-onset bacterial etiologies. We found a high prevalence of early-onset bacterial coinfection during severe COVID-19 pneumonia, with a high proportion of S. aureus. Our data support the current WHO guidelines for the management of severe COVID-19 patients, in whom antibiotic therapy directed to respiratory pathogens is recommended.

Keywords: Bacterial coinfection; Coronavirus disease 2019; Intensive care unit; Pneumonia; Staphylococcus aureus.

Conflict of interest statement

The authors have no conflict of interest to declare.”
++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Annals of the American Thoracic Society:

https://www.atsjournals.org/doi/10.1513/AnnalsATS.202009-1093RL

“Hospitalized patients, particularly those who are critically ill, are at risk for “secondary” infections (1, 2). Initial reports of patients hospitalized with coronavirus disease (COVID-19) indicate that 10–33% develop bacterial pneumonia (3, 4) and 2–6% develop bloodstream infection (BSI) (5, 6). Few studies have reported patient characteristics or the impact of intensive care unit (ICU) admission on secondary infections (3, 6–8). We conducted a descriptive study to identify the prevalence, microbiology, and outcomes of secondary pneumonias and BSIs in patients hospitalized with COVID-19.”