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

PLoS One. 2022 Aug 1;17(8):e0272375. doi: 10.1371/journal.pone.0272375. eCollection 2022.


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.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria
  • Bacterial Infections* / drug therapy
  • Bacterial Infections* / epidemiology
  • Bacterial Infections* / microbiology
  • COVID-19 Drug Treatment*
  • COVID-19* / epidemiology
  • Coinfection* / drug therapy
  • Coinfection* / epidemiology
  • Coinfection* / microbiology
  • Humans
  • Prevalence


  • Anti-Bacterial Agents

Grants and funding

The author(s) received no specific funding for this work.