Prevalence and Clinical Impact of Coinfection in Patients with Coronavirus Disease 2019 in Korea

Abstract

Coinfection rates with other pathogens in coronavirus disease 2019 (COVID-19) varied during the pandemic. We assessed the latest prevalence of coinfection with viruses, bacteria, and fungi in COVID-19 patients for more than one year and its impact on mortality. A total of 436 samples were collected between August 2020 and October 2021. Multiplex real-time PCR, culture, and antimicrobial susceptibility testing were performed to detect pathogens. The coinfection rate of respiratory viruses in COVID-19 patients was 1.4%. Meanwhile, the rates of bacteria and fungi were 52.6% and 10.5% in hospitalized COVID-19 patients, respectively. Respiratory syncytial virus, rhinovirus, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans were the most commonly detected pathogens. Ninety percent of isolated A. baumannii was non-susceptible to carbapenem. Based on a multivariate analysis, coinfection (odds ratio [OR] = 6.095), older age (OR = 1.089), and elevated lactate dehydrogenase (OR = 1.006) were risk factors for mortality as a critical outcome. In particular, coinfection with bacteria (OR = 11.250), resistant pathogens (OR = 11.667), and infection with multiple pathogens (OR = 10.667) were significantly related to death. Screening and monitoring of coinfection in COVID-19 patients, especially for hospitalized patients during the pandemic, are beneficial for better management and survival.

Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19

“…In the previous studies, the rate of bacterial co-infection in COVID-19 patients varied from 2.7–52.6%. 10 11 12 13 14 15 16 One meta-analysis study published in 2020 found bacterial coinfection in 4.9% of COVID-19 patients on hospital admission and 16.0% on ICU admission. 21 In another meta-analysis study, 7% of hospitalized COVID-19 patients had bacterial co-infection, a number that increased to 14% in studies that only included ICU patients.…”

“…First, the rates of bacterial co-infection in COVID-19 patients varied from 2.7–52.6% according to hospital settings and regional differences. 10 11 12 13 14 15 16 Second, microbiological testing for bacterial co-infection was conducted in less than half of the study population in most of the studies, which can lead to a substantial bias. 10 13 17 18 19 The purpose of this study was to answer two clinical questions for hospitalized COVID-19 patients: 1) the frequency of bacterial co-infection and 2) the clinical effect of empirical antimicrobial therapy.…”

Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection

“…Our findings contradict the opinion of some researchers who speculate that seasonal respiratory viruses (e.g., RV) have a shorter incubation period than SARS CoV-2 and induce the production of interferon, which inhibits SARS CoV-2 replication (38). Jeong et al (24) reported that the median cycle threshold value of SARS-CoV-2 testing was slightly elevated in patients with coinfection. In another study, the differences in the mean Ct values between specimens with and without coinfection were not statistically significant (39).…”

In vitro and in vivo Characterization of Host–Pathogen Interactions of the L3881 Candida albicans Clinical Isolate

“…Candida albicans is a human commensal fungus and the etiologic agent of infections in skin, oral and esophageal cavities, gastrointestinal tract, lungs, and bloodstream in immunocompromised individuals ( Kadosh and Lopez-Ribot, 2013 ; Lemberg et al, 2022 ). Although it is considered an opportunistic fungus, C. albicans is the most common cause of nosocomial fungal infections, with a mortality rate of ∼40% in patients with systemic infections ( Gudlaugsson et al, 2003 ; Perlroth et al, 2007 ; Erami et al, 2022 ; Jeong et al, 2022 ). Due to its severity, nosocomial candidemia contributes to prolonged hospitalization, increased healthcare costs, and increased morbidity and mortality rates ( Perlroth et al, 2007 ; Arendrup, 2010 ; Kullberg and Arendrup, 2015 ; Erami et al, 2022 ; Jeong et al, 2022 ).…”

“…Although it is considered an opportunistic fungus, C. albicans is the most common cause of nosocomial fungal infections, with a mortality rate of ∼40% in patients with systemic infections (Gudlaugsson et al, 2003;Perlroth et al, 2007;Erami et al, 2022;Jeong et al, 2022). Due to its severity, nosocomial candidemia contributes to prolonged hospitalization, increased healthcare costs, and increased morbidity and mortality rates (Perlroth et al, 2007;Arendrup, 2010;Kullberg and Arendrup, 2015;Erami et al, 2022;Jeong et al, 2022).…”