Frequent antibiotic use in COVID-19 patients exacerbates antimicrobial resistance. This systematic review and meta-analysis determined the prevalence and predictors of bacterial infections and antimicrobial resistance in COVID-19 patients. 148 studies (362,976 patients) showed a 5.3% prevalence of bacterial co-infection and 18.4% of secondary bacterial infection. Antimicrobial resistance was highly prevalent (60.8% of infections and 37.5% of isolates). Higher resistance was associated with low-income/middle-income settings, ICU admission, IL-6 inhibitor use, and diabetes. The study highlights the urgent need for global surveillance and careful antibiotic use in COVID-19 patients.

BJ Langford, V Leung, MDN Daneman, Lana Dalla, J-P R Soucy, Leslie Dan, PharmDM Simeonova, J Lo, N Daneman, PharmDT Kan, MDK Mponponsuo, S Bertagnolio, MDA Cassini, DrBradley J Lanford, Miranda So, Marina Simeonova, Jennifer Lo, Tiffany Kan, Sumit Raybardhan, Mia E Sapin, Kwadwo Mponponsuo, Ashley Farrell, Elizabeth Leung, Jean-Paul R Soucy, Alessandro Cassini, Derek Macfadden, Nick Daneman, Silvia Bertagnolio