Co-infection in patients with hypoxemic pneumonia due to COVID-19 in Reunion Island

Abstract

This study aimed to evaluate the incidence of co-infection with different types of pathogens in patients with hypoxemic pneumonia due to coronavirus disease 2019 (COVID-19) in Reunion Island. This observational study using a prospectively collected database of hypoxemic pneumonia due to COVID-19 cases was conducted at Félix Guyon University Hospital in Reunion Island, France. Between 18 March 2020 and 15 April 2020, 156 patients were admitted to our hospital for COVID-19. A total of 36 patients had hypoxemic pneumonia (23.1%) due to COVID-19. Thirty of these cases (83.3%) were imported by travelers returning mainly from metropolitan France and Spain. Patients were screened for co-infection with other pathogens at admission: 31 (86.1%) by multiplex polymerase chain reaction (PCR) and 16 (44.4%) by cytobacteriological examination of sputum culture. Five patients (13.9%) were found to have co-infection: 1 with influenza virus A H1N1 (pdm09) associated with Branhamella catarrhalis , 1 with Streptococcus pneumoniae associated with Haemophilus influenzae , 1 with Human Coronavirus 229E, 1 with Rhinovirus, and 1 with methicillin-susceptible Staphylococcus aureus . Patients with co-infection had higher D-dimer levels than those without co-infection (1.36 [1.34–2.36] μg/mL vs 0.63 [0.51–1.12] μg/mL, P = .05). The incidence of co-infection in our cohort was higher than expected (13.9%). Three co-infections (with influenza virus A(H1N1) pdm09, Streptococcus pneumoniae , and Staphylococcus aureus ) required specific treatment. Patients with hypoxemic pneumonia due to COVID-19 should be screened for co-infection using respiratory cultures or multiplex PCR. Whilst our study has a number of limitations, the results from our study suggest that in the absence of screening, patients should be commenced on treatment for co-infection in the presence of an elevated D-dimer.

Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis

“…The current meta-analysis is more comprehensive and included a total of 71 studies [2,80] and one abstract [3], including a total of 31,953 patients. The inclusion of 18 recently published studies [2,3,[5][6][7][8][9][10][12][13][14]22,24,27,41,62,64,65] contributed to the refinement of the estimate of the pooled prevalence of pathogens contributing to coinfections in SARS-CoV-2 patients.…”

“…Of the initial 7317 retrieved publications, there were 4609 duplicate articles, and 2080 articles were found to be irrelevant based on their titles and abstracts and were excluded. An additional 1065 articles were excluded after review, meaning that we included 72 articles in the systematic review [80][81][82], while 68 articles were included in the meta-analysis [2][3][4][5][6][7][8][9][10][11][39][40][41][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][59][60][61][62][63][64][65][66][67][68][69][70][80][81][82] (Figure 1).…”

“…Thus, timely diagnosis is important to initiate appropriate therapy and limit the overuse of antimicrobial agents. Previous studies, including case series [2,5,8,11,[14][15][16]19,20,, cohort studies [3,4,6,7,9,10,12,13,17,18,21,22,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70], and meta-analyses [71][72][73], have shown variable results. In light of recent studies evaluating coinfections in SARS-CoV-2 patients, we aimed to re-evaluate the prevalence of bacterial, fungal, and respiratory viral coinfections in a comprehensive meta-analysis.…”

“…Globally, as of 15 April 2021, there have been 137,866,311 confirmed cases of COVID-19, including 2,965,707 deaths, as reported by the World Health Organization [ 1 ]. Coinfection with SARS-CoV-2 and other bacterial, fungal, and respiratory viral pathogens [ 2 , 3 , 4 ], Gram-positive and Gram-negative bacteria [ 5 , 6 , 7 ], Middle East respiratory syndrome coronavirus (MERS-CoV) [ 8 ], and influenza [ 9 , 10 , 11 , 12 , 13 ] has been described. However, the reported frequency is variable.…”

“…Thus, timely diagnosis is important to initiate appropriate therapy and limit the overuse of antimicrobial agents. Previous studies, including case series [ 2 , 5 , 8 , 11 , 14 , 15 , 16 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], cohort studies [ 3 , 4 , 6 , 7 , 9 , 10 , 12 , 13 , 17 , 18 , 21 , 22 , 51 , 52 , 53 , 54 , 55 , …”