Microbial coinfections and superinfections in critical COVID-19: a Kenyan retrospective cohort analysis

Abstract

Objectives To outline the burden, risk factors and outcomes for critical COVID-19 patients with co-infections or superinfections. Methods This was a retrospective descriptive study of adults who were admitted with critical COVID-19 for ≥ 24 hours. Data collected included demographic profiles and other baseline characteristics, laboratory and radiological investigations, medical interventions, and clinical outcomes. Outcomes of interest included presence or absence of co-infections and superinfections and in-hospital mortality. Differences between those with and without co-infections and superinfections were compared for statistical significance. Results We reviewed 321 patient records. Baseline characteristics included a median age (IQR) of 61.4 (51.4-72.9) years, male (71.3%) and African/black predominance (66.4%). Death occurred in 132 (44.1%) patients with significant difference noted between those with added infections (58.2%) compared to those with none (36.6%) (p = 0.002, odds ratio (OR) = 2.41). One patient had co-infection with pulmonary tuberculosis. Approximately two-thirds of patients received broad-spectrum antimicrobial therapy. Conclusion Added infections in critically ill COVID-19 patients were relatively uncommon but where present, were associated with higher mortality. Empiric use of broad spectrum antimicrobials was common and may have led to selection of multidrug resistant organisms. More robust local data on antimicrobial susceptibility patterns may help in appropriate antibiotic selection to improve outcomes without driving up rates of drug resistant pathogens.

Bacterial profiles and their antibiotic resistance background in superinfections caused by multidrug‐resistant bacteria among COVID‐19 ICU patients from southwest Iran

“…The detection of bacterial pathogens in COVID‐19 patients after 48 h of hospital admission was considered as superinfection. 13 Before hospital admission of each patient, SARS‐CoV‐2 was detected and confirmed by a SARS‐CoV‐2 reverse transcription‐quantitative polymerase chain reaction (RT‐qPCR) assay using nasopharyngeal swabs. Also, specialists from the hospital's radiology department evaluated the chest computer tomography scans and/or radiographs for signs of pneumonia.…”

“…Previous reports, including case series, 11 , 12 cohort and cross‐sectional studies, 13 , 14 and meta‐analyses, 15 , 16 have provided variable findings on co‐infection and superinfection with respiratory pathogens in COVID‐19 patients from different regions. The causative pathogens of respiratory co‐infections and superinfections can be numerous, either common or uncommon, such as bacteria, viruses, and fungi.…”

“…Early detection of the causal agents of comorbid infections and assessment of antibiotic resistance are critical for the management, control, and treatment of patients with severe COVID-19 infections and save patients' lives. 10 Previous reports, including case series, 11,12 cohort and crosssectional studies, 13,14 and meta-analyses, 15,16…”

Pathophysiology of Methicillin-Resistant Staphylococcus aureus Superinfection in COVID-19 Patients

“…Coronaviruses are the emerging pathogens that cause epidemics and pandemics worldwide. The data on COVID-19 with bacterial coinfections have been widely reported, but the superinfections have a few reports with a limited number of sample size [ 23 , 24 ]. MRSA is a difficult-to treat-infection and is on the high priority list of the World Health Organization for new antibiotic discovery [ 7 , 8 , 25 ].…”

The Assessment of Multiplex PCR in Identifying Bacterial Infections in Patients Hospitalized with SARS-CoV-2 Infection: A Systematic Review

“…Antibiotics are still given to patients even though the treatment for COVID-19 does not involve the prescription of antibiotics. This is done in the hope of eliminating any potential bacterial infections that may be present, as the mortality rates are higher in patients who have a co-infection or a superinfection [ 27 , 28 , 29 ]. In spite of the fact that antibiotic use may be helpful, it is important to point out that there is a potential danger of developing antimicrobial resistance when using antibiotics; as a result, the choice of whether or not to receive antibiotic therapy ought to be considered carefully [ 30 , 31 , 32 ].…”