Implications of empirical testing and treatment for atypical bacteria in patients hospitalized with COVID, influenza, or RSV: a retrospective observational cohort study

Abstract

Purpose Patients admitted with viral respiratory tract infections are at risk ofbacterial co-infections that may exacerbate disease severity. Detection of atypical bacteria requires specific laboratory diagnostic modality and specific antibiotics. Methods In this retrospective regionwide cohort study we included all patients admitted to a hospital in the Central Denmark Region with COVID-19, influenza A, influenza B, or Respiratory Syncytial Virus (RSV) from February 2019 to February 2024. Firstly, we investigated the number of patients testing positive for atypical bacterial co-infection. Secondly, we evaluated associations with diagnostic testing for these atypical bacteria, and the use and associations with administration of empirical treatment with clarithromycin. Results During the study period a total of 19,651 patients were admitted with one of the viral respiratory tract infections. Only 21 patients tested positive for atypical bacterial co-infection, corresponding to 0.1% of those tested ( n = 2,369). Empirical clarithromycin was administered to 859 (4.4%) patients. Still 17 out of the 21 patients (81.0%) with atypical bacterial co-infection did not receive clarithromycin before the result of diagnostic test was available. Conclusions Our findings do not support routine testing for atypical bacterial co-infection and use of empirical treatment for atypical pneumonia in this population.

Bibliographic Information