Bacterial Co-infection in Critically Ill COVID-19 Patients

Pavankumar Kamat.


April 22, 2021


  • Bacterial co-infection/co-colonisation was not common in patients with COVID-19 infection within 48 hours of hospital admission.

  • However, the rate of gram-negative bacterial infection, especially Klebsiella pneumoniae and Escherichia coliwas higher during intensive care unit (ICU) stay.

Why this matters

  • A better understanding of bacterial co-infection in patients with COVID-19 is crucial for effective antimicrobial stewardship.

Study design

  • A retrospective cohort study of 254 patients with COVID-19 infection (age, >16 years) admitted to 7 ICUs in England up to May 2020.

  • The proportion and type of organisms were identified at ≤48 and >48 hours following hospital admission, corresponding to community and hospital-acquired co-infections.

  • Funding: NIHR Nottingham Biomedical Research Centre.

Key results

  • Overall, co-infection/co-colonisation was identified in 83 (32.7%) patients from hospital admission to the end of ICU stay.

  • Bacterial co-infection/co-colonisation was identified within 48 hours of admission in 14 (5.5%) patients

    • Staphylococcus aureus (4 patients) and Streptococcus pneumoniae (2 patients) were common pathogens.

  • The rate of gram-negative bacterial infection increased with length of stay (LOS) in ICU. 

    • Klebsiella pneumoniae (23 patients) and Escherichia coli (20 patients) identified as common pathogens.

  • The rate of co-infection/co-colonisation at >48 hours after hospital admission was 27/1000 person-days (95% CI, 21.3-34.1).

  • Patients with co-infection/co-colonisation vs those without were more likely to die in ICU (OR, 1.78; 95% CI, 1.03-3.08; P=.04) and had a longer hospital LOS (sub-HR for discharge from ICU, 0.53; 95% CI, 0.39-0.71; P<.001).


  • Retrospective design.


Baskaran V, Lawrence H, Lansbury LE, Webb K, Safavi S, Zainuddin NI, Huq T, Eggleston C, Ellis J, Thakker C, Charles B, Boyd S, Williams T, Phillips C, Redmore E, Platt S, Hamilton E, Barr A, Venyo L, Wilson P, Bewick T, Daniel P, Dark P, Jeans AR, McCanny J, Edgeworth JD, Llewelyn MJ, Schmid ML, McKeever TM, Beed M, Lim WS. Co-infection in critically ill patients with COVID-19: an observational cohort study from England. J Med Microbiol. 2021;70(4). doi: 10.1099/jmm.0.001350. PMID: 33861190. View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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