COVID-19 related secondary bacterial pneumonia ~Comparisons with influenza~

Main Article Content

Masafumi Seki, MD, PhD


The presence of secondary bacterial infection is important in viral infectious disease. Influenza is known to become more severe with secondary bacterial pneumonia in particular when the Streptococcus pneumoniae and Haemophilus influenzae are co-infected, but with COVID-19, there are thought to be few concomitant bacterial infections. However, mortality in COVID-19 patients also increases with secondary bacterial infections, mainly Staphylococcus aureus such as MRSA and Gram-negative bacilli, and vigilance is needed. Consequently, there is a rising trend in prescriptions for antibiotics, but more appropriate diagnosis and antimicrobial stewardship are needed to suppress antimicrobial resistance, and vaccination will be the key strategy to prevent the severe viral infections related with secondary bacterial infection.

Keywords: Antibiotics, Antimicrobial Stewardship Antimicrobial Resistance, Co-infection, SARS-CoV-2, Secondary infection

Article Details

How to Cite
SEKI, Masafumi. COVID-19 related secondary bacterial pneumonia ~Comparisons with influenza~. Medical Research Archives, [S.l.], v. 10, n. 1, jan. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 13 apr. 2024. doi:
Research Articles


1. Seki M. Lessons from the Nationwide Surveillance of SARS-CoV-2 Surges in Japan. JMA J 2021; 4: 302-3.
2. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA 2020; 180: 934-43.
3. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. lancet 2020; 395: 497-506.
4. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9.
5. Arima Y, Kanou K, Arashiro T, et al. Epidemiology of COVID-19 in Japan: descriptive findings and lessons learned through surveillance during the first three waves. JMA Journal 2021; 4: 198-206..
6. Matthay MA, Leligdowicz A, Liu KD. Biological Mechanisms of COVID-19 Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2020; 202: 1489-91..
7. Seki M. Trends in the management of infectious disease under SARS-CoV-2 era: From pathophysiological comparison of COVID-19 and influenza. World J Virol 2021; 10( 62-8.
8. Bhimraj A, Morgan R, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis 2020: doi: 10.1093/cid/ciaa478.
9. Ishida T, Seki M, Oishi K, et al. Clinical manifestations of adult patients requiring influenza-associated hospitalization: A prospective multicenter cohort study in Japan via internet surveillance. J Infect Chemother 2021; 27: 480-5.
10. Uyeki TM, Bernstein H, Bradley JS, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clinical Infect Dis 2019; 68: 895-902.
11. Metlay JP, Waterer GW,, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-e67.
12. Iverson AR Boyd K, McAuley JL, Plano LR, Hart ME, McCullers JA. Influenza virus primes mice for pneumonia from Staphylococcus aureus. J Infect Dis 2011; 203: 880-8..
13. McCullres JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006; 19: 571-81
14. Seki M, Kohno S, Newstead MW, et al. Critical role of IL-1 receptor-associated kinase-M in regulating chemokine-dependent deleterious inflammation in murine influenza pneumonia. J Immunol 2010; 184: 1410-8.
15. Seki M, Kosai K, Yanagihara,K, et al. Disease severity in patients with simultaneous influenza and bacterial pneumonia. Intern Med 2007; 46: 953-8.
16. Seki M, Fuke R, Oikawa N, Hariu M, Watanabe Y. Association of influenza with severe pneumonia/empyema in the community, hospital, and healthcare-associated setting. Respir Med Case Rep 2016; 24.
17. Seki M, Yanagihara K, Higashiyama Y, et al. Immunokinetics in severe pneumonia due to influenza virus and bacteria coinfection in mice. Eur Respir J 2004; 24: 143-9.
18. Hamaguchi S, Seki M, Yamamoto N, et al. Case of invasive nontypable Haemophilus influenzae respiratory tract infection with a large quantity of neutrophil extracellular traps in sputum. J Inflamm Res 2012; 5: 137-40.
19. Morens DM, Morens DM, Taubenberger J, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis 2008; 198: 962-70.
20. Mauad T, Hajjar L, Callegari GD, et al. Lung pathology in fatal novel human influenza A (H1N1) infection. Am J Respir Crit Care Med 2010; 181: 72-9.
21. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, Soucy JR, Daneman N. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020; 26: 1622-9.
22. Manohar P, Loh B, Nachimuthu R, Hua X, Welburn SC, Leptihn S. Secondary Bacterial Infections in Patients With Viral Pneumonia. Front Med (Lausanne) 2020; 5: 420..
23. Spoto S Spoto S VE, Riva E, et al.. A Staphylococcus aureus Coinfection on a COVID-19 Pneumonia in a Breast Cancer Patient. Int J Gen Med 2020; 30: 729-33.
24. Sutton SS, , Magagnoli J, Cummings T, Hardin J. Association Between the Use of Antibiotics, Antivirals, and Hospitalizations Among Patients With Laboratory-confirmed Influenza. Clin Infect Dis 2021; 72: 566-73.
25. Maeda M, Muraki Y, Kosaka T, et al. The first nationwide survey of antimicrobial stewardship programs conducted by the Japanese Society of Chemotherapy. J Infect Chemother 2019; 25: 83-8.
26. Dyar OJ Huttner B, Schouten J, Pulcini C; ESGAP (ESCMID Study Group for Antimicrobial stewardshiP). What is antimicrobial stewardship? Clin Microbiol Infect 2017; 23: 793-8.
27. Seki M. Strategies for Geriatric Pneumonia in Healthcare Facilities -How Effective is Combined Influenza and Pneumococcal Vaccination? International Journal of General Medicine 2020; 13: 663-6.
28. Polack FP, Thomas S, Kitchin N,et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Eng J mEd 2020; 383: 2603-15.
29. Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KRW, Pollard AJ. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Lancet Infect Dis 2021; 21: e26-35.
30. Christopoulou I, Roose K, Ibañez LI, Saelens X. Influenza vaccines to control influenza-associated bacterial infection: where do we stand? Expert Rev Vaccines 2015; 14: 55-67.
31. Christenson B, Lundbergh P, Hedlund J, Ortqvist A. Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study. Lancet 2001; 357: 1008-11.
32. Tsuchiya M, Miyazaki H, Takata M, et al. Comparative characteristics of the background and blood test findings in adults with pneumococcal pneumonia and invasive pneumococcal disease: A retrospective study. J Infect Chemother 2021; 16: S1341-321X(21)00338-X. .