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1/6 At yesterday's Emory IM COVID #JournalClub, I presented a great article ( @SHEA_Epi) on bacterial/fungal co-infection among COVID patients - from the Bronx at the height of the pandemic!
Here are some
highlights from the study by Nori et al. #MedTwitter #tweetorial
Here are some
highlights from the study by Nori et al. #MedTwitter #tweetorial
2/6 First, it looked at all #COVID patients Mar 1-Apr 18, which was ~ the pandemic zenith in NYC. (Visual aid from @COVID19Tracking via @TheAtlantic). Total (+) by PCR? 4,267.
3/6 Then, they did a retrospective chart review. Total patients with (+) respiratory or bloodstream cultures? 152.
For those crunching the numbers, that's just 3.6%!
For those crunching the numbers, that's just 3.6%!
4/6 And that 3.6% was pretty sick:
95% 
cultures = ICU
54% of 
cultures = CVCs, HD catheters, etc.
8 candidemia (7/8 = #CLABSI)
CRP & Procal were not helpful in distinguishing [COVID] from [COVID+co-infection]. Ex.IQR was 0-37 CRP, 0-10 procal.
95% cultures = ICU 54% of cultures = CVCs, HD catheters, etc. 8 candidemia (7/8 = #CLABSI)CRP & Procal were not helpful in distinguishing [COVID] from [COVID+co-infection]. Ex.
IQR was 0-37 CRP, 0-10 procal.
5/6 Most also seemed to develop those infections after arrival: median time-to-(+) 7d for and 6d for . A lot of co-infections were in immunocompromised (55%).
Yet 71% of ALL COVID(+) patients in the study got antibiotics. ?
? As the authors say, "a significant mismatch."
and 6d for . A lot of co-infections were in immunocompromised (55%).Yet 71% of ALL COVID(+) patients in the study got antibiotics. ?
? As the authors say, "a significant mismatch."
6/6 So what should we take away?
Bacterial/fungal co-infection is rare (3.6%) in COVID
Look for it in the very sick (tubes/lines) who are already admitted
Don't forget candida 
Don't rely on CXR, CRP, or Procal
Be judicious with antibiotics!
Bacterial/fungal co-infection is rare (3.6%) in COVID Look for it in the very sick (tubes/lines) who are already admitted Don't forget candida Don't rely on CXR, CRP, or Procal Be judicious with antibiotics!
Bonus/ Check out the isolate breakdown (155 from / 112 from ).
/ 112 from ).
