Secondary bacterial infections in patients with COVID-19

Coronavirus Disease 2019 (COVID-19) has been classified as a global threat, affecting millions of people and killing thousands. It is caused by the SARS-CoV-2 virus, which emerged at the end of 2019 in Wuhan, China, quickly spreading worldwide. Patients’ clinical features vary, and secondary infections represent a constant risk of increased mortality among those who need hospitalization. Damaged respiratory epithelium and dysregulation of the immune response are the main pathophysiological mechanisms of increased microbial adhesion to the airway epithelial cells and the development of secondary infections. However, the exact incidence of secondary infections in COVID-19 patients is not thoroughly known (3.2%–80%) due to limited and heterogeneous studies that lead to conflicting or non-comparable results. Infection-risk stratification in critically ill patients includes early ICU admission (within 48 hours from hospitalization), age, comorbidity, immunosuppressive drugs administration, and disease severity indexes (oxygenation, inflammation, and cytolysis score). In treating secondary infections, the local epidemiology (which usually includes multidrug-resistant strains) and the modification of any antibiotic regimen according to the cultures’ results are critical. Prompt and appropriate antimicrobial agents represent the cornerstone in secondary infection treatment for COVID-19 hospitalized patients. © 2021 Lachana A. et al.