Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis
Background: Coinfection with bacteria, fungi, and respiratory viruses in SARS-CoV-2 is of particular importance due to the possibility of increased morbidity and mortality. In this meta-analysis, we calculated the prevalence of such coinfections. Methods: Electronic databases were searched from 1 De...
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| Format: | Article |
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MDPI AG
2021-06-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/10/7/809 |
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| author | Saad Alhumaid Abbas Al Mutair Zainab Al Alawi Abeer M. Alshawi Salamah A. Alomran Mohammed S. Almuhanna Anwar A. Almuslim Ahmed H. Bu Shafia Abdullah M. Alotaibi Gasmelseed Y. Ahmed Ali A. Rabaan Jaffar A. Al-Tawfiq Awad Al-Omari |
| author_facet | Saad Alhumaid Abbas Al Mutair Zainab Al Alawi Abeer M. Alshawi Salamah A. Alomran Mohammed S. Almuhanna Anwar A. Almuslim Ahmed H. Bu Shafia Abdullah M. Alotaibi Gasmelseed Y. Ahmed Ali A. Rabaan Jaffar A. Al-Tawfiq Awad Al-Omari |
| author_sort | Saad Alhumaid |
| collection | DOAJ |
| description | Background: Coinfection with bacteria, fungi, and respiratory viruses in SARS-CoV-2 is of particular importance due to the possibility of increased morbidity and mortality. In this meta-analysis, we calculated the prevalence of such coinfections. Methods: Electronic databases were searched from 1 December 2019 to 31 March 2021. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results: Of the 6189 papers that were identified, 72 articles were included in the systematic review (40 case series and 32 cohort studies) and 68 articles (38 case series and 30 cohort studies) were included in the meta-analysis. Of the 31,953 SARS-CoV-2 patients included in the meta-analysis, the overall pooled proportion who had a laboratory-confirmed bacterial infection was 15.9% (95% CI 13.6–18.2, n = 1940, 49 studies, <i>I<sup>2</sup></i> = 99%, <i>p <</i> 0.00001), while 3.7% (95% CI 2.6–4.8, n = 177, 16 studies, <i>I<sup>2</sup></i> = 93%, <i>p <</i> 0.00001) had fungal infections and 6.6% (95% CI 5.5–7.6, n = 737, 44 studies, <i>I<sup>2</sup></i> = 96%, <i>p <</i> 0.00001) had other respiratory viruses. SARS-CoV-2 patients in the ICU had higher co-infections compared to ICU and non-ICU patients as follows: bacterial (22.2%, 95% CI 16.1–28.4, <i>I<sup>2</sup></i> = 88% versus 14.8%, 95% CI 12.4–17.3, <i>I<sup>2</sup></i> = 99%), and fungal (9.6%, 95% CI 6.8–12.4, <i>I<sup>2</sup></i> = 74% versus 2.7%, 95% CI 0.0–3.8, <i>I<sup>2</sup></i> = 95%); however, there was an identical other respiratory viral co-infection proportion between all SARS-CoV-2 patients [(ICU and non-ICU) and the ICU only] (6.6%, 95% CI 0.0–11.3, <i>I<sup>2</sup></i> = 58% versus 6.6%, 95% CI 5.5–7.7, <i>I<sup>2</sup></i> = 96%). Funnel plots for possible publication bias for the pooled effect sizes of the prevalence of coinfections was asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry (<i>p</i> values < 0.05). Conclusion: Bacterial co-infection is relatively high in hospitalized patients with SARS-CoV-2, with little evidence of <i>S. aureus</i> playing a major role. Knowledge of the prevalence and type of co-infections in SARS-CoV-2 patients may have diagnostic and management implications. |
| first_indexed | 2024-03-10T10:03:23Z |
| format | Article |
| id | doaj.art-336054dce98e43cc9efbdad630cb6812 |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-03-10T10:03:23Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pathogens |
| spelling | doaj.art-336054dce98e43cc9efbdad630cb68122023-11-22T01:44:24ZengMDPI AGPathogens2076-08172021-06-0110780910.3390/pathogens10070809Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-AnalysisSaad Alhumaid0Abbas Al Mutair1Zainab Al Alawi2Abeer M. Alshawi3Salamah A. Alomran4Mohammed S. Almuhanna5Anwar A. Almuslim6Ahmed H. Bu Shafia7Abdullah M. Alotaibi8Gasmelseed Y. Ahmed9Ali A. Rabaan10Jaffar A. Al-Tawfiq11Awad Al-Omari12Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi ArabiaResearch Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi ArabiaDivision of Allergy and Immunology, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi ArabiaDepartment of Pharmacy, King Fahad Hofuf Hospital, Al-Ahsa 36441, Saudi ArabiaDepartment of Pharmacy, King Fahad Hofuf Hospital, Al-Ahsa 36441, Saudi ArabiaDepartment of Pharmacy, Maternity and Children Hospital, Al-Ahsa 36422, Saudi ArabiaDepartment of Pharmacy, Maternity and Children Hospital, Al-Ahsa 36422, Saudi ArabiaDepartment of Pharmacy, Alomran Hospital, Al-Ahsa 36355, Saudi ArabiaDepartment of Pharmacy, Prince Sultan Cardiac Center, Al-Ahsa 36441, Saudi ArabiaResearch Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi ArabiaMolecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi ArabiaInfectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi ArabiaCollege of Medicine, Alfaisal University, Riyadh 11533, Saudi ArabiaBackground: Coinfection with bacteria, fungi, and respiratory viruses in SARS-CoV-2 is of particular importance due to the possibility of increased morbidity and mortality. In this meta-analysis, we calculated the prevalence of such coinfections. Methods: Electronic databases were searched from 1 December 2019 to 31 March 2021. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results: Of the 6189 papers that were identified, 72 articles were included in the systematic review (40 case series and 32 cohort studies) and 68 articles (38 case series and 30 cohort studies) were included in the meta-analysis. Of the 31,953 SARS-CoV-2 patients included in the meta-analysis, the overall pooled proportion who had a laboratory-confirmed bacterial infection was 15.9% (95% CI 13.6–18.2, n = 1940, 49 studies, <i>I<sup>2</sup></i> = 99%, <i>p <</i> 0.00001), while 3.7% (95% CI 2.6–4.8, n = 177, 16 studies, <i>I<sup>2</sup></i> = 93%, <i>p <</i> 0.00001) had fungal infections and 6.6% (95% CI 5.5–7.6, n = 737, 44 studies, <i>I<sup>2</sup></i> = 96%, <i>p <</i> 0.00001) had other respiratory viruses. SARS-CoV-2 patients in the ICU had higher co-infections compared to ICU and non-ICU patients as follows: bacterial (22.2%, 95% CI 16.1–28.4, <i>I<sup>2</sup></i> = 88% versus 14.8%, 95% CI 12.4–17.3, <i>I<sup>2</sup></i> = 99%), and fungal (9.6%, 95% CI 6.8–12.4, <i>I<sup>2</sup></i> = 74% versus 2.7%, 95% CI 0.0–3.8, <i>I<sup>2</sup></i> = 95%); however, there was an identical other respiratory viral co-infection proportion between all SARS-CoV-2 patients [(ICU and non-ICU) and the ICU only] (6.6%, 95% CI 0.0–11.3, <i>I<sup>2</sup></i> = 58% versus 6.6%, 95% CI 5.5–7.7, <i>I<sup>2</sup></i> = 96%). Funnel plots for possible publication bias for the pooled effect sizes of the prevalence of coinfections was asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry (<i>p</i> values < 0.05). Conclusion: Bacterial co-infection is relatively high in hospitalized patients with SARS-CoV-2, with little evidence of <i>S. aureus</i> playing a major role. Knowledge of the prevalence and type of co-infections in SARS-CoV-2 patients may have diagnostic and management implications.https://www.mdpi.com/2076-0817/10/7/809SARS-Cov-2co-infectioncoinfectionCOVID-19concurrentbacterial |
| spellingShingle | Saad Alhumaid Abbas Al Mutair Zainab Al Alawi Abeer M. Alshawi Salamah A. Alomran Mohammed S. Almuhanna Anwar A. Almuslim Ahmed H. Bu Shafia Abdullah M. Alotaibi Gasmelseed Y. Ahmed Ali A. Rabaan Jaffar A. Al-Tawfiq Awad Al-Omari Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis Pathogens SARS-Cov-2 co-infection coinfection COVID-19 concurrent bacterial |
| title | Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis |
| title_full | Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis |
| title_fullStr | Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis |
| title_short | Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis |
| title_sort | coinfections with bacteria fungi and respiratory viruses in patients with sars cov 2 a systematic review and meta analysis |
| topic | SARS-Cov-2 co-infection coinfection COVID-19 concurrent bacterial |
| url | https://www.mdpi.com/2076-0817/10/7/809 |
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