Worldwide prevalence of microbial agents’ coinfection among COVID‐19 patients: A comprehensive updated systematic review and meta‐analysis

Abstract

Background To provide information about pathogens’ coinfection prevalence with SARS‐CoV‐2 could be a real help to save patients’ lives. This study aims to evaluate the pathogens’ coinfection prevalence among COVID‐19 patients. Method In order to find all of the relevant articles, we used systematic search approach. Research‐based databases including PubMed, Web of Science, Embase, and Scopus, without language restrictions, were searched to identify the relevant bacterial, fungal, and viral coinfections among COVID‐19 cases from December 1, 2019, to August 23, 2021. In order to dig deeper, other scientific repositories such as Medrxiv were probed. Results A total of 13,023 studies were found through systematic search. After thorough analysis, only 64 studies with 61,547 patients were included in the study. The most common causative agents of coinfection among COVID‐19 patients were bacteria (pooled prevalence: 20.97%; 95% CI: 15.95–26.46; I2: 99.9%) and less frequent were virus coinfections (pooled prevalence: 12.58%; 95% CI: 7.31–18.96; I2: 98.7%). The pooled prevalence of fungal coinfections was also 12.60% (95% CI: 7.84–17.36; I2: 98.3%). Meta‐regression analysis showed that the age sample size and WHO geographic region did not influenced heterogeneity. Conclusion We identified a high prevalence of pathogenic microorganism coinfection among COVID‐19 patients. Because of this rate of coinfection empirical use of antibacterial, antifungal, and antiviral treatment are advisable specifically at the early stage of COVID‐19 infection. We also suggest running simultaneously diagnostic tests to identify other microbiological agents’ coinfection with SARS‐CoV‐2.

Performance evaluation of STANDARD Q COVID‐19 Ag home test for the diagnosis of COVID‐19 during early symptom onset

“… 2 Infection with SARS‐CoV‐2 may alter the human's microbiota, which further may affect the immune system. 3 Based on a systematic review, 4 a high prevalence of pathogenic microorganism was found among COVID‐19 patients. Thus, a delayed detection of SARS‐CoV‐2 could also result in increased mortality and morbidity due to the possibility of coinfection of SARS‐CoV‐2 and other pathogens.…”

Oropharyngeal Candidiasis among Egyptian COVID-19 Patients: Clinical Characteristics, Species Identification, and Antifungal Susceptibility, with Disease Severity and Fungal Coinfection Prediction Models

“…Case severity, morbidity, and mortality are affected by age, individual physiology, and pre-existing chronic conditions such as diabetes and hypertension. Moreover, microbial coinfections alter the disease pathophysiology and affect the recovery outcomes of patients [ 14 ]. Bacterial and fungal co-infections have been reported during previous influenza pandemic outbreaks.…”

“…were the main causative agents. Co-infections further increased morbidity and mortality rates [ 14 , 15 , 16 , 17 , 18 ]. Likewise, severely and critically ill COVID-19 patients with COVID pneumonia or developing ARDS are reported to be particularly vulnerable to bacterial and fungal superinfection, especially those hospitalized in an ICU on invasive or non-invasive ventilation [ 19 , 20 ].…”

Evaluation of conventional and point‐of‐care real‐time RT‐PCR tests for the detection of SARS‐CoV‐2 through a pooled testing strategy

“… 3 Mass testing against SARS‐CoV‐2 and in some circumstances alone with other bacterial, viral, or fungal microbiota is also encouraged for a wide range of COVID‐19 control measures, such as screening for community transmission 4 and evaluation for disease progression of COVID‐19 patients with/without coinfection of other microbial agents. 5 , 6 , 7 , 8 …”

“…3 Mass testing against SARS-CoV-2 and in some circumstances alone with other bacterial, viral, or fungal microbiota is also encouraged for a wide range of COVID-19 control measures, such as screening for community transmission 4 and evaluation for disease progression of COVID-19 patients with/without coinfection of other microbial agents. [5][6][7][8] Pooling of clinical specimens for mass detection of SARS-CoV-2 by nucleic acid testing has been reported to be effective in increasing diagnostic capacity with sufficient accuracy [9][10][11] for prompt disease intervention, especially when the prevalence of infected cases is low. In Taiwan, routine diagnosis of COVID-19 among individuals with suspected disease is conducted through a comprehensive nationwide SARS-CoV-2 laboratory network that comprises a total of 245 clinical laboratories at regional hospitals and medical institutions with a maximum daily capacity of 149,660 tests as of September 27, 2021.…”