Bacterial Co-Infection in Patients with COVID-19 Hospitalized (ICU and Not ICU): Review and Meta-Analysis

Abstract

The prevalence of patients hospitalized in ICUs with COVID-19 and co-infected by pathogenic bacteria is relevant in this study, considering the integrality of treatment. This systematic review assesses the prevalence of co-infection in patients admitted to ICUs with SARS-CoV-2 infection, using the PRISMA guidelines. We examined the results of the PubMed, Embase, and SciELO databases, searching for published English literature from December 2019 to December 2021. A total of 542 rec ords were identified, but only 38 were eligible and, and of these only 10 were included. The tabulated studies represented a sample group of 1394 co-infected patients. In total, 35%/138 of the patients were co-infected with Enterobacter spp., 27% (17/63) were co-infected with methicillin-sensitive Staphylococ cus aureus, 21% (84/404) were co-infected with Klebsiella spp., 16% (47/678) of patients were co-infected with coagulase-negative Staphylococcus, 13% (10/80) co-infected with Escherichia coli (ESBL), and 3% (30/1030) of patients were co-infected with Pseudomonas aeruginosa. The most common co-infections were related to blood flow; although in the urinary and respiratory tracts of patients Streptococcus pneumoniae was found in 57% (12/21) of patients, coagulase negative Staphylococcus in 44% (7/16) of patients, and Escherichia coli was found in 37% (11/29) of patients. The present research demonstrated that co-infections caused by bacteria in patients with COVID-19 are a concern.

Bacterial Pulmonary Co-Infections on ICU Admission: Comparison in Patients with SARS-CoV-2 and Influenza Acute Respiratory Failure: A Multicentre Cohort Study

“…This study found a lower prevalence of pulmonary bacterial co-infections on admission to an ICU in patients with SARS-CoV-2 pneumonia (8.2%) than in patients with influenza pneumonia (24.8%). In the literature, the rates of early bacterial co-infections at diagnosis of SARS-CoV-2 pneumonia at ICU admission ranged from 3% [ 8 ] to 20% [ 9 ], with a higher prevalence reported in cohorts that included a vast majority of patients on mechanical ventilation ( Table S1 ) [ 4 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. In 254 patients admitted to seven ICUs in England during the first wave, the rate of documented bacterial coinfections was 5.5% [ 10 ].…”

“…Such results were in agreement with previous findings that in influenza pneumonia, the two bacteria most frequently identified were first S. Pneumoniae and then S. aureus with average rates of 40% and 20%, respectively [ 1 , 2 , 24 ]. In SARS-CoV-2 pneumonia, S aureus was more frequently prevalent than S. pneumoniae , accounting for 30% vs. 20% of documented co-infections [ 4 , 9 , 10 , 16 ]; other major etiologic agents of co-infections were Haemophilus in more than 10% of the cases [ 4 , 9 , 13 , 15 ] and Enterobacter spp. in more than 25% of the cases [ 9 , 14 ].…”

Unfavorable Outcome and Long-Term Sequelae in Cases with Severe COVID-19

“…In a recent review analysis [ 24 ], up to 35% of cases were co-infected with Enterobacter spp., 27% with methicillin-susceptible Staphylococcus aureus, 21% with Klebsiella spp. 6% coagulase-negative Staphylococcus, 13% with Escherichia coli and 3% with Pseudomonas aeruginosa .…”

Snapshot of COVID-19 superinfections in Marseille hospitals: where are the common pathogens?

“…Interestingly, S. pneumoniae and S. aureus were the most frequent aetiological agents of community-acquired bacterial pneumonia, while enterobacteria and Pseudomonas aeruginosa were mostly found in healthcare-associated infections. Although a number of published studies have reported cases of co-infections with COVID-19 [5][6][7][8][9][10], they were conducted with a limited number of patients, often without a control group, thereby rendering it difficult to deduce whether such infections are actually associated with the acquisition of COVID-19 [11].…”