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healthysoch
New Delhi, May 21, 2021 :
Co-infections and superinfections with other pathogens in patients with SARS-CoV-2 have often been reported. However, there is no clarity on the frequency of co-infection and superinfections by other pathogens and associated clinical outcomes among patients having SARS-CoV-2 infection.
While co-infection has been defined as the recovery of other respiratory pathogens in SARS-CoV-2 infected patients at the time of diagnosis of SARS-CoV-2 infection, superinfection has been defined as recovery of other respiratory pathogens during treatment of SARS-CoV-2 infection.
A meta-analysis has been published recently in PLOS One which noted that 19% of patients with COVID-19 had co-infection with other pathogens, while 24% patients with COVID-19 had a superinfection. The meta-analysis included 118 studies, of which around half were retrospective cohort studies, 35% case series, and 9% prospective cohort studies.
Sixty seven of the studies (57%) reported on co-infections, 44 (37%) reported on superinfections, and 7 (6%) reported on both co-infections and superinfections in COVID-19 patients.
- The pooled prevalence of co-infection was 19% (95% confidence interval [CI] 14-25; I2 = 98%), with the highest prevalence seen in non-ICU patients (29%). The pooled prevalence of superinfection was 24%, with the highest being in ICU patients (41%).
- Bacterial superinfections had a prevalence of 20%, which was followed by viral co-infections at 10%, bacterial co-infections at 8% and fungal superinfections at 8%. Viral superinfections and fungal co-infections had a prevalence of 4% each.
- Among patients with co-infections, the most common causative bacteria included Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus. The most common viruses in patients with co-infections included influenza type A, influenza type B and respiratory syncytial virus. Aspergillus was the most commonly identified fungus among patients with a co-infection.
- In patients with superinfections, the most frequent bacteria included Acinetobacter spp., Pseudomonas and Escherichia coli, while the most frequently detected virus was Rhinovirus. Candida sp. was the most frequently identified fungus.
- The mortality risk was higher among patients with a co-infection or superinfection compared to those with only SARS-CoV-2 infection (odds ratio [OR] 3.31).
The data presented in the meta-analysis has significant implications. The authors emphasize that protocols for respiratory virus diagnostic testing must consider the fact that co-infection with SARS-CoV-2 is common. Management approach must also involve co-infection evaluation in order to provide adequate treatment for SARS-CoV-2 as well as the co-infection.
Author :Dr Shashank R Joshi, Padma Shri Awardee,
MD, DM, FICP, FACP (USA), FACE(USA), FRCP (Lon, Glsg & Edin)
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