Bacterial co-infections and secondary infections are commonly identified in severe influenza (23%) and other severe respiratory viral infections, in which they are associated with increased morbidity and mortality. National and International COVID-19 guidelines vary in their recommendations on empirical antimicrobial therapy, some recommend empirical antimicrobial therapy in severe diseases where others do not.

In a study published in the Lancet, “co-infection at hospital admission was rare and when infections were identified, most were secondary. Gram-negative and S aureus were the most frequently recovered pathogens from respiratory and blood cultures. These findings have implications for empirical therapy, indicating a need to treat Gram-negative bacteria and S aureus empirically until culture results are available”.

Despite little evidence of bacterial infections in the patients studied, a high proportion of these patients received antimicrobials. When infections were identified they were mostly secondary. We have our land legs back now, we need to be paying close attention to our antibiotic stewardship efforts, be sure we are not over-treating, that our physicians are aware of the risks associated with overuse of antibiotics and our staff is trained on the appropriate criteria that should be met prior to beginning antibiotic therapy. Stay well, stay informed, and stay tuned!