Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19 : a systematic review and meta-analysis

Alshaikh, Faisal Salman and Sindi, Oula Nawaf and Godman, Brian and Seaton, R Andrew and Kurdi, Amanj (2022) Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19 : a systematic review and meta-analysis. PLoS ONE, 17 (8). e0272375. ISSN 1932-6203 (

[thumbnail of Alshaikh-etal-PLOSOne-2022-Prevalence-of-bacterial-coinfection-and-patterns-of-antibiotics-prescribing-in-patients]
Text. Filename: Alshaikh_etal_PLOSOne_2022_Prevalence_of_bacterial_coinfection_and_patterns_of_antibiotics_prescribing_in_patients.pdf
Final Published Version
License: Creative Commons Attribution 4.0 logo

Download (3MB)| Preview


Background: Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR). Aim: To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients Data Source: OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. Study Eligibility: English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting Participants: Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting. Methods: Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design. Results: A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26 – 10.31) and 61.77% (CI 50.95 – 70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30-14.18). Conclusion: Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.