Risk factors for bacterial infections in patients with moderate to severe COVID‐19: A case‐control study

Nasir, Nosheen; Rehman, Fazal; Omair, Syed Furrukh

Adverse outcomes in coronavirus infection disease‐19 (COVID‐19) patients are not always due to the direct effects of the viral infection, but often due to bacterial coinfection. However, the risk factors for such bacterial coinfection are hitherto unknown. A case‐control study was conducted to determine risk factors for bacterial infection in moderate to critical COVID‐19. Out of a total of 50 cases and 50 controls, the proportion of cases with severe/critical disease at presentation was 80% in cases compared to 30% in controls (p < 0.001). The predominant site was hospital‐acquired pneumonia (72%) and the majority were Gram‐negative organisms (82%). The overall mortality was 30%, with comparatively higher mortality among cases (42% vs. 18%; p = 0.009). There was no difference between procalcitonin levels in both groups (p = 0.883). In multivariable logistic regression analysis, significant independent association was found with severe/critical COVID‐19 at presentation (AOR: 4.42 times; 95% CI: 1.63–11.9) and use of steroids (AOR: 4.60; 95% CI: 1.24–17.05). Notably, 64% of controls were administered antibiotics despite the absence of bacterial coinfection or secondary infection. Risk factors for bacterial infections in moderate to critically ill patients with COVID‐19 include critical illness at presentation and use of steroids. There is widespread empiric antibiotic utilization in those without bacterial infection.