Fungal and bacterial coinfections increase mortality of severely ill COVID-19 patients

Abstract

Background SARS-CoV-2 predisposes patients to secondary infections; however, a better understanding of the impact of coinfections on the outcome of hospitalized COVID-19 patients is still necessary. Aim To analyse death risk due to coinfections in COVID-19 patients. Methods We evaluated the Odds of death of 212 severely ill COVID-19 patients, with detailed focus on the risks for each pathogen, site of infection, comorbidities and length of hospitalization. Findings The mortality rate was 50.47%. Fungal and/or bacterial isolation occurred in 89 patients, of which 83.14% died. Coinfected patients stayed hospitalized longer and had an increased Odds of dying (OR = 13.45, R 2 =0.31). The risk of death was increased by bacterial (OR=11.28) and fungal (OR=5.97) coinfections, with increased levels of creatinine, leukocytes, urea and C-reactive protein. Coinfections increased the risk of death if patients suffer from cardiovascular disease (OR= 11.53), diabetes (OR=6.00) or obesity (OR=5.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for negative-coagulase Staphylococcus (OR=25.39), Candida non- albicans (OR=11.12), S. aureus (OR=10.72), Acinetobacter spp. (OR=6.88), Pseudomonas spp. (OR=4.77) and C. albicans (OR=3.97). The high-risk sites of infection were blood, tracheal aspirate and urine. Patients with coinfection undergoing invasive mechanical ventilation were 3.8 times more likely to die than those without positive cultures. Conclusions Severe COVID-19 patients with secondary coinfections required longer hospitalization and had higher risk of death. The early diagnosis of coinfections is essential to identify high-risk patients and to determine the right interventions to reduce mortality.

Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients

“…However, the presence of fungi in blood or respiratory tract fluid was an indicator of the patient’s severe condition and a prognosticator for poor clinical outcome, which presented as an 89.5% 30-day mortality in our patient cohort. Such observation is consistent with the results of a study performed in Brazil, where mechanically-ventilated patients with positive cultures were 3.8 times more likely to die than those without superinfections [ 69 ]. Lastly, we were not able to assess whether any of the isolates developed antifungal drug resistance during the antifungal treatment and whether the susceptibility pattern is characteristic for this health center.…”

Acinetobacter baumannii Infections in Times of COVID-19 Pandemic

“…A Japanese tertiary hospital reported an OXA-23-producing A. baumannii outbreak in 5 of 10 ICU beds, and all isolates had similar antibiotic susceptibility patterns with resistance to all β-lactams, including imipenem [ 107 ]. Of interest, an outbreak of A. baumannii was a determining factor in the increases of the incidence of infection and the morbi-mortality of ICU patients, with all strains multidrug resistant and only sensitive to colistin [ 108 ]. Gottesman et al described a monoclonal outbreak of CRAb in two wards of a dedicated hospital to treat COVID-19 patients.…”

“…Acinetobacter spp. was the second most isolated of the patients with positive bacterial cultures and was responsible for the third-highest mortality rate of COVID-19 patients suffering from these coinfections [ 108 ].…”

Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients

“…This disease has predisposed a relatively high number of patients to acute respiratory distress syndrome, and co-infections are a frequent complication [ 5 , 6 ], especially with prolonged hospital stays [ 7 ]. Changes in humans’ microbiota have been recently observed in COVID-19 patients [ 1 ], with patients often being colonized or infected by microorganisms responsible for secondary infections (co-infections or superinfections), often caused by bacteria and fungal pathogens [ 5 , 7 , 8 , 9 ]. Indeed, several opportunistic infections following severe respiratory viral infections have been recognized in COVID-19 patients [ 2 ]—particularly, a higher incidence of fungal co-infections ( Figure 1 ) [ 10 , 11 , 12 ].…”

“…There is still lack of information regarding the long-term impact of secondary infections on the outcome of hospitalized COVID-19 patients [ 9 , 16 ]. Patients with co-infection undergoing invasive mechanical ventilation showed to be 3.8 times more likely to die than those without positive cultures [ 9 ].…”