Co-Infections in People with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Objectives: In previous influenza pandemics, bacterial co-infections have been a major cause of mortality. We aimed to evaluate the burden of co-infections in patients with COVID-19. Methods:We systematically searched Embase, Medline, Cochrane Library, LILACS and CINAHL for eligible studies published from 1 January 2020 to 17 April 2020. We included patients of all ages, in all settings. The main outcome was the proportion of patients with a bacterial, fungal or viral co-infection. . Results:Thirty studies including 3834 patients were included. Overall, 7% of hospitalised COVID-19 patients had a bacterial co-infection (95% CI 3-12%, n=2183, I 2 =92•2%). A higher proportion of ICU patients had bacterial co-infections than patients in mixed ward/ICU settings (14%, 95% CI 5-26, I 2 =74•7% versus 4%, 95% CI 1-9, I 2 = 91•7%). The commonest bacteria were Mycoplasma pneumonia, Pseudomonas aeruginosa and Haemophilus influenzae. The pooled proportion with a viral co-infection was 3% (95% CI 1-6, n=1014, I 2 =62•3%), with Respiratory Syncytial Virus and influenza A the commonest. Three studies reported fungal co-infections. Conclusions:A low proportion of COVID-19 patients have a bacterial co-infection; less than in previous influenza pandemics. These findings do not support the routine use of antibiotics in the management of confirmed COVID-19 infection.

The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

“…In another report that was published from a UK secondary care setting, 27 among 836 patients (3.2%) had early confirmed bacterial isolates identified (0-5 days post-admission), rising to 51 cases (6.1%) during the admission. In a study conducted in Shiraz, Iran, in 2009, Hassanzadeh et al suggested that ICU-acquired infections were documented in 51.7% of ICU patients, with a mortality rate of 10.9% (5 patients) 22,23 . Our finding was relatively higher among other studies.…”

The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

“…In another report that was published from a UK secondary care setting, 27 among 836 patients (3.2%) had early confirmed bacterial isolates identified (0-5 days post-admission), rising to 51 cases (6.1%) during the admission. In a study conducted in Shiraz, Iran, in 2009, Hassanzadeh et al suggested that ICU-acquired infections were documented in 51.7% of ICU patients, with a mortality rate of 10.9% (5 patients) 21,22 . Our finding was relatively higher among other studies.…”

“…Among gram-negative bacteria, the Enterobacteriaceae family being the most commonly found and multidrug-resistant organisms, including Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum β-lactamase (ESBL)producing or carbapenemase-producing Enterobacteriaceae, are increasingly being reported worldwide 23 . The identification of bacterial infection with gram-negative organisms is more reflected as a complication of ICU care and is not suggested as a specific predilection for co-infections in COVID-19 22 .…”

Unusual Clinical and Biochemical Presentations of Severe Covid-19 Pneumonia Managed in General Ward

“…We got 75% lung involvement in HRCT chest on Day 20. The increased levels of all these markers also seem to indicate the onset of a cytokine storm in patients 12 .…”

“…In a study by Chen et al 52% of patients had elevated IL-6 levels at admission. Increased IL-6 levels have been associated with increased risk of death 12 . In our case we could not do the IL-6 level.This was our limitation.…”