Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review

Abstract

Background Endemic to the hospital environment, Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with S. aureus remains unclear. Therefore, we aimed to perform a high-quality scoping review of the literature to synthesize the existing evidence on the clinical outcomes of COVID-19 and S. aureus co-infection. Methods A scoping review of the literature was conducted in PubMed, Scopus, Ovid MEDLINE, CINAHL, ScienceDirect, medRxiv, and the WHO COVID-19 database using a combination of terms. Articles that were in English, included patients infected with both COVID-19 and S. aureus, and provided a description of clinical outcomes for patients were eligible. From these articles, the following data were extracted: type of staphylococcal species, onset of co-infection, patient sex, age, symptoms, hospital interventions, and clinical outcomes. Quality assessments of final studies were also conducted using the Joanna Briggs Institute’s critical appraisal tools. Results Searches generated a total of 1922 publications, and 28 articles were eligible for the final analysis. Of the 115 co-infected patients, there were a total of 71 deaths (61.7%) and 41 discharges (35.7%), with 62 patients (53.9%) requiring ICU admission. Patients were infected with methicillin-sensitive and methicillin-resistant strains of S. aureus, with the majority (76.5%) acquiring co-infection with S. aureus following hospital admission for COVID-19. Aside from antibiotics, the most commonly reported hospital interventions were intubation with mechanical ventilation (74.8 %), central venous catheter (19.1 %), and corticosteroids (13.0 %). Conclusions Given the mortality rates reported thus far for patients co-infected with S. aureus and COVID-19, COVID-19 vaccination and outpatient treatment may be key initiatives for reducing hospital admission and S. aureus co-infection risk. Physician vigilance is recommended during COVID-19 interventions that may increase the risk of bacterial co-infection with pathogens, such as S. aureus, as the medical community’s understanding of these infection processes continues to evolve.

Bacterial and Fungal Co-Infections and Superinfections in a Cohort of COVID-19 Patients: Real-Life Data from an Italian Third Level Hospital

“…To fight the inflammatory syndrome, many immunomodulant agents are used, such as corticosteroids, anti-interleukin-1 (IL-1), anti-interleukin-6 (IL-6), and inhibitors of the JAK-STAT pathway [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. The use of immune suppressive drugs, combined with the natural immune suppression caused by the virus, can lead to a surge of secondary bacterial and fungal infections [ 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Secondary Complement Deficiency Impairs Anti-Microbial Immunity to Klebsiella pneumoniae and Staphylococcus aureus During Severe Acute COVID-19

“…Acquired complement deficiency and low levels of C3, C4 and CH 50 were previously reported to increase the risk of infection caused by S. aureus infection ( 55 ). A defect in complement opsonisation of S. aureus in sera of patients with acute severe COVID-19 may be a contributing factor to the previously reported high increase of nosocomial Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) infections in these patients ( 10 ).…”

“…The transition from an opportunistic commensal to an invasive pathogen requires evasion from the immune defence and the ability of the bacterium to exploit different niches within the host. Secondary infections caused by S. aureus and methicillin-resistant Staphylococcus aureus (MRSA) are commonly feared, especially among immunocompromised and severely ill patients as they contribute to further morbidity and mortality ( 10 ). The increased risk for S. aureus infections during COVID-19 was reported in previous studies showing an association between secondary infections with S. aureus and MRSA and mortality ( 10 , 11 ).…”

Methicillin-resistant Staphylococcus aureus lung infection in coronavirus disease 2019: how common?

“…A recent scoping review was conversely aimed to synthetize available evidence on clinical outcomes in patients with COVID-19 and S. aureus coinfection, reporting a crude mortality of 65% in 115 coinfected patients (mostly bacteremia, followed by pneumonia) from 28 studies, also including case reports [ 23 ]. Mortality was not stratified in detail for methicillin susceptibility [ 23 ].…”