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

Alhumaid, Saad; Mutair, Abbas Al; Alawi, Zainab Al; Alshawi, Abeer M.; Alomran, Salamah A.; Almuhanna, Mohammed S.; Almuslim, Anwar A.; Shafia, Ahmed H. Bu; Alotaibi, Abdullah M.; Ahmed, Gasmelseed Y.; Rabaan, Ali A.; Al‐Tawfiq, Jaffar A.; Al‐Omari, Awad

doi:10.3390/pathogens10070809

Cited by 55 publications

(54 citation statements)

References 103 publications

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“…There are observational studies that have noted a lack of SARS-CoV-2 coinfections with other respiratory viruses within a single host (Blasco et al, 2020 ; Kim et al, 2020 ; Nowak et al, 2020 ; Xing et al, 2020 ; Alhumaid et al, 2021 ). While this could be attributed to the limited circulation of other respiratory viruses, other studies suggest that the limited number of coinfections might be due to virus-virus interactions within the host (Dee et al, 2021 ; Stowe et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Consequences of Viral Interference: A Mathematical Modeling Study of Two Interacting Viruses

Pinky

Dobrovolny

2022

Front. Microbiol.

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Some viruses have the ability to block or suppress growth of other viruses when simultaneously present in the same host. This type of viral interference or viral block has been suggested as a potential interaction between some respiratory viruses including SARS-CoV-2 and other co-circulating respiratory viruses. We explore how one virus' ability to block infection with another within a single host affects spread of the viruses within a susceptible population using a compartmental epidemiological model. We find that population-level effect of viral block is a decrease in the number of people infected with the suppressed virus. This effect is most pronounced when the viruses have similar epidemiological parameters. We use the model to simulate co-circulating epidemics of SARS-CoV-2 and influenza, respiratory syncytial virus (RSV), and rhinovirus, finding that co-circulation of SARS-CoV-2 and RSV causes the most suppression of SARS-CoV-2. Paradoxically, co-circulation of SARS-CoV-2 and influenza or rhinovirus results in almost no change in the SARS-CoV-2 epidemic, but causes a shift in the timing of the influenza and rhinovirus epidemics.

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Section: Introductionmentioning

confidence: 99%

Epidemiological Consequences of Viral Interference: A Mathematical Modeling Study of Two Interacting Viruses

Pinky

Dobrovolny

2022

Front. Microbiol.

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“…Therefore, these patients should be identified at the earliest and treated preferably in a special care set up to avoid morbidity and mortality. It is worth mentioning increasing age in patients may result in increased hospital stay and might put SARS-CoV-2 patients at risk to develop medical complications like coagulopathy, pneumonia, acute respiratory distress syndrome, organ failure and nosocomial coinfections [ 97 , 101 ]. The presence of these factors in severely ill patients may have necessitated the use of advanced therapies like renal replacement therapy or ventilator support which would have delayed hospital discharge [ 102 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Diabetol Metab Syndr

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Background One possible reason for increased mortality due to SARS-CoV-2 in patients with diabetes is from the complication of diabetic ketoacidosis (DKA). Objectives To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature) were searched from 1 December 2019 to 30 June 2021 in the English language using the following keywords alone or in combination: COVID-19 OR SARS-CoV-2 AND diabetic ketoacidosis OR DKA OR ketosis OR ketonemia OR hyperglycaemic emergency OR hyperglycaemic crisis. We included studies in adults and children of all ages in all healthcare settings. Binary logistic regression model was used to explore the effect of various demographic and biochemical parameters variables on patient’s final treatment outcome (survival or death). Results Of the 484 papers that were identified, 68 articles were included in the systematic review and meta-analysis (54 case report, 10 case series, and 4 cohort studies). Studies involving 639 DKA patients with confirmed SARS-CoV-2 [46 (7.2%) were children and 334 (52.3%) were adults] were analyzed. The median or mean patient age ranged from < 1 years to 66 years across studies. Most of the patients (n = 309, 48.3%) had pre-existing type 2 diabetes mellitus. The majority of the patients were male (n = 373, 58.4%) and belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity. The median random blood glucose level, HbA1c, pH, bicarbonate, and anion gap in all included patients at presentation were 507 mg/dl [IQR 399–638 mg/dl], 11.4% [IQR 9.9–13.5%], 7.16 [IQR 7.00–7.22], 10 mmol/l [IQR 6.9–13 mmol/l], and 24.5 mEq/l [18–29.2 mEq/l]; respectively. Mortality rate was [63/243, 25.9%], with a majority of death in patients of Hispanic ethnicity (n = 17, 27%; p = 0.001). The odd ratios of death were significantly high in patients with pre-existing diabetes mellitus type 2 [OR 5.24, 95% CI 2.07–15.19; p = 0.001], old age (≥ 60 years) [OR 3.29, 95% CI 1.38–7.91; p = 0.007], and male gender [OR 2.61, 95% CI 1.37–5.17; p = 0.004] compared to those who survived. Conclusion DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [≥ 60 years old], male gender, BMI ≥ 30, blood glucose level > 1000 mg/dl, and anion gap ≥ 30 mEq/l.

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“…Lack of well-defined management plan for COVID-19 disease results in the use of various treatment and adjuvant therapies in patients during hospital stay. Nonetheless, considering the high number and severity of bacterial co-infections previously reported in patients with SARS-CoV-2, initiation of antibiotic therapy for all hospitalized patients with COVID-19 is recommended [ 55 , 56 ]. The approach of administering empiric antibiotic therapy solely to patients who were admitted for SARS-CoV-2 and who presented with a chest X-ray suggestive of bacterial infection, have a need for direct ICU admission, or are severely immunocompromised should be reconsidered [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation support for SARS-CoV-2: a multi-centered, prospective, observational study in critically ill 92 patients in Saudi Arabia

et al. 2021

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Background Extracorporeal membrane oxygenation (ECMO) has been used as a rescue strategy in patients with severe with acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection, but there has been little evidence of its efficacy. Objectives To describe the effect of ECMO rescue therapy on patient-important outcomes in patients with severe SARS-CoV-2. Methods A case series study was conducted for the laboratory-confirmed SARS-CoV-2 patients who were admitted to the ICUs of 22 Saudi hospitals, between March 1, 2020, and October 30, 2020, by reviewing patient’s medical records prospectively. Results ECMO use was associated with higher in-hospital mortality (40.2% vs. 48.9%; p = 0.000); lower COVID-19 virological cure (41.3% vs 14.1%, p = 0.000); and longer hospitalization (20.2 days vs 29.1 days; p = 0.000), ICU stay (12.6 vs 26 days; p = 0.000) and mechanical ventilation use (14.2 days vs 22.4 days; p = 0.000) compared to non-ECMO group. Also, there was a high number of patients with septic shock (19.6%) and multiple organ failure (10.9%); and more complications occurred at any time during hospitalization [pneumothorax (5% vs 29.3%, p = 0.000), bleeding requiring blood transfusion (7.1% vs 38%, p = 0.000), pulmonary embolism (6.4% vs 15.2%, p = 0.016), and gastrointestinal bleeding (3.3% vs 8.7%, p = 0.017)] in the ECMO group. However, PaO2 was significantly higher in the 72-h post-ECMO initiation group and PCO2 was significantly lower in the 72-h post-ECMO start group than those in the 12-h pre-ECMO group (62.9 vs. 70 mmHg, p = 0.002 and 61.8 vs. 51 mmHg, p = 0.042, respectively). Conclusion Following the use of ECMO, the mortality rate of patients and length of ICU and hospital stay were not improved. However, these findings need to be carefully interpreted, as most of our cohort patients were relatively old and had multiple severe comorbidities. Future randomized trials, although challenging to conduct, are highly needed to confirm or dispute reported observations.

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

Cited by 55 publications

References 103 publications

Epidemiological Consequences of Viral Interference: A Mathematical Modeling Study of Two Interacting Viruses

Epidemiological Consequences of Viral Interference: A Mathematical Modeling Study of Two Interacting Viruses

Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis

Extracorporeal membrane oxygenation support for SARS-CoV-2: a multi-centered, prospective, observational study in critically ill 92 patients in Saudi Arabia

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