Co-infections in people with COVID-19: a systematic review and meta-analysis

Lansbury, Louise; Lim, Benjamin; Baskaran, Vadsala; Lim, Wei Shen

doi:10.1016/j.jinf.2020.05.046

Cited by 1,353 publications

(1,621 citation statements)

References 64 publications

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“…Co-infections in COVID-19 have been described in previous studies (often within larger studies including all hospitalized COVID-19 patients), and reported incidence varies greatly, according to de nition criteria, the heterogeneity of patients included and the diagnostic methods used. We observed a higher incidence of nosocomial infections compared to those reported in some recent meta-analysis [5,6,12]. However, when we compared our results with those of studies that only included COVID-19 patients hospitalized in the ICU, we observed more similar results [11,[13][14][15][16].…”

Section: Discussionsupporting

confidence: 74%

“…Some small studies have described the occurrence of infection sustained by MDR gram negative bacteria (Enterobacterales, A. baumannii, P. aeruginosa) [5,12], others have found the commonest bacteria to be Mycoplasma pneumoniae, P. aeruginosa, H. in uenzae and Klebsiella spp. [6]. A recent single centre study from Barcelona reported a similar microbiological pattern to the one we observed, however this study included all hospitalized patients and did not differentiate between infections acquired in the ICU and in hospital wards [25].…”

Section: Discussionmentioning

confidence: 63%

“…Many authors recognize the importance of superinfection but de nitive data is still lacking [4,5]. Reported incidence varies between 3,6% to 43% [6], and no study thus far, has focused speci cally on the subpopulation of ICU patients.…”

Section: Introductionmentioning

confidence: 99%

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Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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Background: Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients.Aim: To assess the characteristics and outcome of ICU-acquired infections in COVID-19 patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%) and urinary tract infection (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 63%

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Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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“…HDL and Apo-AI may help in preventing in ammatory injury and improving the clinical outcome with anti-in ammatory and antioxidative properties. Then, a systematic review and meta-analysis showed that bacterial co-infection occurred in 7% of hospitalized COVID-19 patients and 14% of ICU patients, and the bacterial co-infection would lead to a higher mortality of COVID-19 [37]. Studies showed that HDL was capable to bind and neutralize Gram-negative LPS and Gram-positive lipoteichoic acid (LTA), thus reducing LTA and LPSinduced in ammatory injury [38,39], thus providing the conception that HDL-based therapies might be promising in severe COVID-19 patients with bacterial co-infection.…”

Section: Discussionmentioning

confidence: 99%

Changes in lipid metabolism in patients with severe COVID-19

Li¹,

Zhang²,

Dai³

et al. 2020

Preprint

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Background: Dyslipidemia plays an important role in the pathogenesis and evolution of critical illness, but limited information exists regarding the lipid metabolism of severe coronavirus disease 2019 (COVID-19) patients. The aim of this study was to investigate role of dyslipidemia in patients with severe COVID-19Methods: We retrospectively reviewed 216 severe COVID-19 patients with clarified outcomes (discharged or deceased), admitted to the West Court of Union Hospital in Wuhan, China, between February 1 and March 31, 2020. The dynamic changes of lipid profiles and their relationships with disease severity and clinical outcomes were analyzed.Results: A total of 216 severe COVID-19 patients, including 24 non-survivors and 192 survivors, were included in the final analyses. The levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein AI (Apo-AI) on admission were significantly lower in non-survivors compared to survivors. During hospitalization, low-density lipoprotein cholesterol (LDL-C), total cholesterol(TC), HDL-C and Apo-AI were shown an increasing trend in survivors, but maintained lower levels or shown downward trend in non-survivors. The serum levels of HDL-C and Apo-AI were inversely correlated with C-reactive protein (CRP), length of hospital stay of survivors and disease severity. The receiver operating characteristic (ROC) curve analysis identified a CRP/ HDL-C ratio cut-off value of 62.54 as the predictor for in-hospital mortality (AUC=0.823, Sensitivity=83.3%, Specificity=70.8%). Logistic regression analysis demonstrated that hypertension, neutrophils-to-lymphocytes ratio(NLR), platelet count and high CRP/ HDL-C ratio (>62.54) were independent factors to predict in-hospital mortality.Conclusions: The results demonstrated that dyslipidemia was associated with the inflammatory response, disease severity and poor prognosis of COVID-19. High CRP/ HDL-C ratio may serve as an independently potential predictor for hospital mortality among patients with severe COVID-19.

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“…But even among a wide number of articles reporting on COVID-19 clinical data, only a few have reported secondary infection, mostly without detailed pathogens. Some reported a low proportion of superinfections in hospitalized patients (7-8%) that rose to 14% in ICU, less than in previous in uenza pandemics [46]. According to other data, secondary infections were identi ed in 5%-44% of ICU patients with COVID-19, being bacterial or fungal pneumonia and bloodstream the most frequent infections [47] (23a), as in our cohort (VAP 38.6% and BSI 36.8%), where the total number of superinfections is higher overall.…”

Section: Discussionmentioning

confidence: 90%

Effectiveness of Mid-Regional Pro-Adrenomedullin (MR-proADM) as Prognostic Marker in COVID-19 Critically Ill Patients: an Observational Prospective Study

Montrucchio

Sales

Rumbolo

et al. 2020

Preprint

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Background Due to the lack of validated biomarkers to predict disease progression and mortality in COVID-19 ICU-patients, we tested the effectiveness of mid-regional pro-adrenomedullin (MR-proADM) in comparison to C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH) in predicting outcome.Methods All consecutive COVID-19 adult patients admitted between March and June 2020 to the ICU of the ‘Città della Salute e della Scienza’ hospital in Turin (Italy) were enrolled. MR-proADM, clinical and routine laboratory test were measured within 48 hours from ICU admission, on day 3, 7 and 14. Survival curves difference with MR-proADM cut-off set to 1.8 nmol/L were tested using log-rank test. Predictive ability was compared using area under the curve and 95% confidence interval of different receiver-operating characteristics curves. Potential confounding effects were tested using a logistic regression model. Results Fifty-seven patients were enrolled. ICU and overall mortality were 54.4%. Within the first 24 hours, lymphocytopenia was present in 86%; increased D-dimer and CRP levels were found in 84.2% and 87.7% respectively, while PCT values higher than 0.5 μg/L were observed in 47.4%. MR-proADM, CRP and LDH were significantly different between surviving and non-surviving patients and over time, while PCT, D-dimer and NT-pro-BNP did not show any difference between the groups and over time; lymphocytes count was different between surviving and non-surviving patients only.MR-proADM was higher in dying patients (2.65+2.33vs1.18+0.47, p=0.0001) and a higher mortality characterized patients with MR-proADM exceeding 1.8 nmol/L (p=0.0157). The logistic regression model adjusted for age, gender, cardiovascular disease, diabetes mellitus and PCT values confirmed an odds ratio equal to 10.274 (95%CI 1.970-53.578) (p=0.0057) for MR-proADM higher than 1.8 nmol/L and equal to 22.206 (95%CI 1.56-316.960) (p=0.0223) for cardiovascular disease. Overall, MR-proADM was found to have the best predictive ability (AUC=0.846 – 95%CI 0.779-0.899).Conclusions In COVID-19 ICU-patients, MR-proADM seems able to provide a more precise stratification of disease severity and mortality risk than other biomarkers. Repeated MR-proADM measurement may support a rapid and effective decision-making. Further studies are needed to better explain the mechanisms responsible of the increase in MR-proADM observed in COVID-19 patients.

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Co-infections in people with COVID-19: a systematic review and meta-analysis

Cited by 1,353 publications

References 64 publications

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Changes in lipid metabolism in patients with severe COVID-19

Effectiveness of Mid-Regional Pro-Adrenomedullin (MR-proADM) as Prognostic Marker in COVID-19 Critically Ill Patients: an Observational Prospective Study

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