Bacterial Pneumonia in Patients with Sars-Cov-2 Omicron Infection: A Case Series

Recent SARS-coV-2 subvariants (BQ.1.1, BA.2, BA.4, BA.5, collectively referred to as Omicron) are adept at evading the immune system but tend to be less severe with fewer hospitalizations and deaths. The incidence of bacterial co-infection at time of admission for SARS-COV-2 related illness early in the COVID pandemic was low. In 2022 when few relatively healthy patients were being admitted, we report three patients found to have bacterial co-infection with pneumococcal and staphylococcal species at time of hospital admission. Varying practices abound, including use of procalcitonin as a screening tool for bacterial coinfection in patients with SARS-coV-2 infection despite a recommendation against this practice in recent pneumonia treatment guidelines. In our cases the use of procalcitonin did not lead to antibiotic delay, however we propose a clinical support rule that can be utilized in the Emergency Department to more accurately guide empiric use of antibiotics in this patient population.