Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Gudiol, Carlota; Durà-Miralles, Xavier; Aguilar-Company, Juan; Hernández-Jiménez, Pilar; Martínez-Cutillas, M.; Fernández‐Avilés, Francesc; Machado, Marina; Vázquez, Lourdes; Martín-Dávila, Pilar; Castro, Nathalie De; Abdala, Edson; Sorlí, Luisa; Andermann, Tessa M.; Márquez-Gómez, Ignacio; Morales, Hugo Manuel Paz; Gabilán, F.; Ayaz, Çağlayan Merve; Kayaaslan, Bircan; Aguilar‐Guisado, Manuela; Herrera, Fabián; Royo-Cebrecos, Cristina; Peghin, Maddalena; González-Rico, Claudia; Goikoetxea, Josune; Salgueira, Claudia; Silva‐Pinto, André; Gutiérrez‐Gutiérrez, Belén; Cuéllar, Sandra; Haidar, Ghady; Maluquer, Clara; Marín, Mar; Pallarès, Natàlia; Carratalà, Jordi

doi:10.1016/j.jinf.2021.07.014

Cited by 32 publications

(42 citation statements)

References 33 publications

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“…[ 55 – 57 ], late infections after intubation [ 55 ], and recovery of multidrug-resistant pathogens [ 58 ]. These also extend results to a wider geographic area including South America [ 56 ] and the Middle East [ 59 ], as well as patient populations such as cancer patients [ 60 ] and postmortem studies [ 57 ]. An Italian paper showed bronchoalverolar lavage from 24 critically ill COVID-19 patients tended to grow gram-negative bacteria "predisposed to multidrug resistance" while 24 matched non-COVID-19 controls had more commensal flora such as Haemophilus sp.…”

Section: Discussionsupporting

confidence: 62%

Bacterial and fungal growth in sputum cultures from 165 COVID-19 pneumonia patients requiring intubation: evidence for antimicrobial resistance development and analysis of risk factors

Liu

Yaron

Piraino

et al. 2021

Ann Clin Microbiol Antimicrob

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Background Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial coinfection superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. Methods Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05. Results Average patient age was 68.7 years and LOS 19.9 days. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall did not suggest acute bacterial or fungal infection in 73 (45%) of 165 individuals sampled within 24 h of intubation. Cultures ≥ 1 week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus. Conclusions In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum prior to/around the time of intubation correlated with no culture growth or recovery of normal oral flora ± yeast. Discontinuation of empiric antibacterials should be considered in these patients aided by other clinical findings, history of prior antimicrobials, laboratory testing, and overall clinical course. Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance. Trial registration: Not applicable as this was a retrospective chart review study without interventional arm.

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Section: Discussionsupporting

confidence: 62%

Bacterial and fungal growth in sputum cultures from 165 COVID-19 pneumonia patients requiring intubation: evidence for antimicrobial resistance development and analysis of risk factors

Liu

Yaron

Piraino

et al. 2021

Ann Clin Microbiol Antimicrob

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“…Most immunosuppressed patients receive empiric antibacterial or antifungal agents, which can lead to high costs, side effects, drug–drug interactions, and development of resistance. In a previous report from Europe, North America, and South America, >80% of patients with cancer and COVID-19 received empiric antimicrobials, although only 8% had another infection at the time of COVID-19 diagnosis, and 19% developed secondary infections [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with cancer are vulnerable to infection due to myelosuppression and other forms of direct immune suppression caused by cytotoxic chemotherapy or chronic steroids, side effects of chemotherapy on mechanical barriers (eg, mucositis and skin ulceration), presence of indwelling central venous catheters, and increased exposure to health care facilities [ 8 ]. One study of 684 patients with cancer focused on coinfections showed higher incidence compared with the general population [ 5–7 , 9 ].…”

mentioning

confidence: 99%

Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study

Satyanarayana

Enriquez

Sun

et al. 2022

Open Forum Infectious Diseases

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Background The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and COVID-19, a high-risk group for coinfection. Methods We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed SARS-CoV-2 infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results Among 8,765 patients (hospitalized or not, median age 65 years, 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal; An additional 6.4% only had clinical diagnosis of a co-infection. The adjusted risk of any coinfection was positively associated with age among patients >50 years, male sex, cardiovascular, pulmonary and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, ECOG performance status, progressing cancer, recent cytotoxic chemotherapy, baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and CRP were positively associated with bacterial coinfection risk and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (OR 1.61, 95%CI 1.33-1.95) and fungal (OR 2.20, 95%CI 1.28-3.76) coinfections. Conclusion Viral and fungal coinfections are infrequent among patients with cancer and COVID-19 with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.

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“…Table 3 summarizes single cases of COVID-19 hematologic cancer patients with fungal co-infections. Very recently, a multicenter cohort study of cancer patients with COVID-19 describing the epidemiology, risk factors, and clinical outcomes of co-infections and super-infections has been published [100]. In this large series, hematologic patients represent 43.8% of all cancer patients enrolled.…”

Section: Hematological Malignanciesmentioning

confidence: 99%

When Viruses Meet Fungi: Tackling the Enemies in Hematology

Busca

Marchesi

Cattaneo

et al. 2022

JoF

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The association of invasive fungal infections (IFI) and viral infections has been described in patients with hematologic malignancies (HM), in particular in hematopoietic stem cell transplant recipients. Regrettably, the diagnosis is often challenging, making the treatment inappropriate in some circumstances. The present review takes into consideration the viral infections commonly associated with IFI. Clinical presentation of IFI and viral infections, risk factors, and impact on the outcome of HM patients are discussed throughout the paper.

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Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Cited by 32 publications

References 33 publications

Bacterial and fungal growth in sputum cultures from 165 COVID-19 pneumonia patients requiring intubation: evidence for antimicrobial resistance development and analysis of risk factors

Bacterial and fungal growth in sputum cultures from 165 COVID-19 pneumonia patients requiring intubation: evidence for antimicrobial resistance development and analysis of risk factors

Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study

When Viruses Meet Fungi: Tackling the Enemies in Hematology

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