Almost 1 in 4 COVID-19 patients have another bacterial, viral or fungal infection simultaneously or subsequently, with such patients experiencing worse disease outcomes. In the paper titled "Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis," the researchers examined the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection.
Musuuza, et al. (2021) searched literature databases for studies published from Oct. 1, 2019, through Feb. 8, 2021 and 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.
Of 6,639 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).
The researchers say their study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. They say the presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. They add that their findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.
Reference: Musuuza JS, et al. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLOS. May 6, 2021. https://doi.org/10.1371/journal.pone.0251170
Source: PLOS One
Forest plot of pooled prevalence of co-infection in patients infected with SARS-CoV-2. Courtesy of Musuuza, et al., PLOS ONE, 2021.