Rapid characterisation of co-infection could help save the lives of COVID-19 patients, according to correspondence in Lancet Microbe.
Most fatalities and poor outcomes in both the 1918 and the 2009 H1N1 influenza pandemics were associated with bacterial co-infections, which appears to be the case in the current COVID-19 pandemic.
According to two recent studies in Wuhan, 50 per cent of fatalities in COVID-19 patients had secondary bacterial or fungal infections.
The diagnosis and treatment of co-infections is complex, as they may be pre-existing when patients are infected with SARS-CoV-2, or they may be hospital-acquired. Patients with chronic obstructive pulmonary disease are at high risk for COVID-19, many of whom also have chronic bacterial infections.
Currently, antibiotic use is high (74.5%) in COVID-19 patients admitted to intensive care, making microbiological testing more challenging. These patients are on invasive ventilation for an extended period of time, further increasing their vulnerability to co-infections.
Early diagnosis and frequent testing of hospitalised patients is necessary, with culture-independent techniques to identify several microorganisms simultaneously, such as whole-genome metagenomics.
These tests would provide valuable surveillance data on pathogens causing co-infections and antimicrobial resistance in intensive care, while more effectively treating some of the most severe COVID-19 cases, save lives and use antimicrobials wisely.