Prevalence and outcomes of co-infection and super-infection with SARS-CoV-2 and other pathogens: A Systematic Review and Meta-analysis

Musuuza, Jackson; Watson, Lauren; Parmasad, Vishala; Putman-Buehler, Nathan; Christensen, Leslie; Safdar, Nasia

doi:10.1101/2020.10.27.20220566

Cited by 17 publications

(32 citation statements)

References 71 publications

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“…They defined co-infection as the recovery of other respiratory pathogens in patients with SARS-CoV-2 infection at the time of a SARS-CoV-2 infection diagnosis and superinfection as the subsequent recovery of other respiratory pathogens during care for patients infected with SARS-CoV-2. Doing this, they found that as many as 12% of patients with COVID-19 had co-infections and as many as 14% superinfections, the latter being associated with poor outcomes [141]. Bacterial co-infections occurred in 4% (95% CI: 1-8%), and superinfections in 6% (95% CI: 2-11%), viral coinfections occurred in 4% (95% CI: 2-7%) and superinfections in 2% (95% CI: 0-7%), and fungal co-infections in 4% (95% CI: 1-8%), and fungal superinfections in 4% (95% CI 0-11%).…”

Section: How To Treat Cap In the Covid-19 Eramentioning

confidence: 98%

“…However, in the literature reviewed there is often not a clear delineation made by the authors between co-infections and secondary/superinfections. In the most recent preprint of a systematic review and meta-analysis, the authors attempted to dissect out co-infections from superinfections [141]. They defined co-infection as the recovery of other respiratory pathogens in patients with SARS-CoV-2 infection at the time of a SARS-CoV-2 infection diagnosis and superinfection as the subsequent recovery of other respiratory pathogens during care for patients infected with SARS-CoV-2.…”

Section: How To Treat Cap In the Covid-19 Eramentioning

confidence: 99%

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The role of co-infections and secondary infections in patients with COVID-19

2021

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Background It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. However, it is still unclear what exact roles co-infections and/or superinfections play in patients with COVID-19 infection. Main body This was an extensive review of the current literature regarding co-infections and superinfections in patients with SARS-CoV-2 infection. The definitions used were those of the Centers for Disease Control and Prevention (US), which defines coinfection as one occurring concurrently with the initial infection, while superinfections are those infections that follow on a previous infection, especially when caused by microorganisms that are resistant, or have become resistant, to the antibiotics used earlier. Some researchers have envisioned three potential scenarios of bacterial/SARS-CoV-2 co-infection; namely, secondary SARS-CoV-2 infection following bacterial infection or colonisation, combined viral/bacterial pneumonia, or secondary bacterial superinfection following SARS-CoV-2. There are a myriad of published articles ranging from letters to the editor to systematic reviews and meta-analyses describing varying ranges of co-infection and/or superinfection in patients with COVID-19. The concomitant infections described included other respiratory viruses, bacteria, including mycobacteria, fungi, as well as other, more unusual, pathogens. However, as will be seen in this review, there is often not a clear distinction made in the literature as to what the authors are referring to, whether true concomitant/co-infections or superinfections. In addition, possible mechanisms of the interactions between viral infections, including SARS-CoV-2, and other infections, particularly bacterial infections are discussed further. Lastly, the impact of these co-infections and superinfections in the severity of COVID-19 infections and their outcome is also described. Conclusion The current review describes varying rates of co-infections and/or superinfections in patients with COVID-19 infections, although often a clear distinction between the two is not clear in the literature. When they occur, these infections appear to be associated with both severity of COVID-19 as well as poorer outcomes.

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Section: How To Treat Cap In the Covid-19 Eramentioning

confidence: 98%

Section: How To Treat Cap In the Covid-19 Eramentioning

confidence: 99%

The role of co-infections and secondary infections in patients with COVID-19

2021

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“…This scale consists of 27 items that assess study characteristics, such as internal validity (bias and confounding), statistical power, and external validity. We scored studies as low risk (score 20-27, medium risk (score [15][16][17][18][19], or high risk (score �14).…”

Section: Plos Onementioning

confidence: 99%

Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis

et al. 2021

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Introduction The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. Patients and methods We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763. Results Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of superinfection was 24% (95% CI: 19%-30%). Pooled prevalence of pathogen type stratified by co- or superinfection were: viral co-infections, 10% (95% CI: 6%-14%); viral superinfections, 4% (95% CI: 0%-10%); bacterial co-infections, 8% (95% CI: 5%-11%); bacterial superinfections, 20% (95% CI: 13%-28%); fungal co-infections, 4% (95% CI: 2%-7%); and fungal superinfections, 8% (95% CI: 4%-13%). Patients with a co-infection or superinfection had higher odds of dying than those who only had SARS-CoV-2 infection (odds ratio = 3.31, 95% CI: 1.82–5.99). Compared to those with co-infections, patients with superinfections had a higher prevalence of mechanical ventilation (45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]), but patients with co-infections had a greater average length of hospital stay than those with superinfections (mean = 29.0 days, standard deviation [SD] = 6.7 vs. mean = 16 days, SD = 6.2, respectively). Conclusions Our study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. The presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. Our findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.

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“…Co-infections, diagnosed around the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, appear to be uncommon occurring in 0.6% to 3.2% of patients [2][3][4][5]. Bacterial respiratory coinfections with Streptococcus pneumoniae or Staphylococcus aureus are the most common causes of coinfections, whereas respiratory viral co-infections appear to be relatively rare [4,6].…”

Section: Introductionmentioning

confidence: 99%

Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Gudiol¹,

Durà-Miralles²,

Aguilar-Company³

et al. 2021

Journal of Infection

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Prevalence and outcomes of co-infection and super-infection with SARS-CoV-2 and other pathogens: A Systematic Review and Meta-analysis

Cited by 17 publications

References 71 publications

The role of co-infections and secondary infections in patients with COVID-19

The role of co-infections and secondary infections in patients with COVID-19

Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis

Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

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