Co-infection at the Time of Hospital Admission in Patients with COVID-19 Infection

Authors

  • Susan Cherian Department of Pathology, Bhabha Atomic Research Centre Hospital (BARCH), Anushakti nagar, Trombay, Mumbai 400-094, Maharashtra, India
  • Sunayana Mukesh Jangla Department of Pathology, Bhabha Atomic Research Centre Hospital (BARCH), Anushakti nagar, Trombay, Mumbai 400-094, Maharashtra, India
  • Raji Naidu Department of Pathology, Bhabha Atomic Research Centre Hospital (BARCH), Anushakti nagar, Trombay, Mumbai 400-094, Maharashtra, India

DOI:

https://doi.org/10.21276/apalm.3170

Keywords:

Bacteria, Co-infection, COVID-19, Fungus, SARS-COV-2

Abstract

Background: Co-infections with Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) lead to unfavourable outcomes. However, data on prevalence of various co-infections in SARS-CoV-2 positive patients on admission to the hospital is sparse. This study focusses on assessing co-infection rates and common pathogenic bacteria and fungus involved in these patients.

Methods: Patients admitted between April 2020 and December 2020 with Corona Virus Disease-2019 (COVID-19) were included. Criteria for co-infection using definitions were developed. All microbiological investigations of these patients performed within first 48 hours of admission were analysed. Their demographic characteristics along with existing co-morbidities, presenting symptoms, other laboratory findings on admission and clinical outcome were also reviewed.

Results: Of 1566 patients, 60% were males.64% belonged to 13-65 years age-group. 4% of COVID-19 positive patients were co-infected. 451 samples were received for culture of which urine were 66%, blood 23% and sputum 11%. 15% samples showed growth of which urine were 19%, blood 10% and sputum 2%. Bacteria isolated were 91% and fungus 9%. The common bacteria isolated were E. coli 46%, Klebsiella pneumoniae 25%, Stenotrophomonas maltophila 6% and Pseudomonas aeruginosa 4%. The common fungus isolated was Candida species 7%.10% of COVID-19 positive patients with co-infection expired and 90% recovered.

Conclusion: We report a 4% rate of bacterial and fungal co-infection in COVID-19 positive patients on admission mostly related to Enterobacterales, Non-fermenting Gram-negative bacilli and Candida species. This data can be valuable in optimising the use of antibiotics and antifungals in our patients. Similar studies on co-infection and its various aspects are the need of the hour.

References

K. Shreenath, Batra P, Vinayaraj E V, Bhatia R, Saikiran, KVP, Singh V, Singh S et al. Coinfections with Other Respiratory Pathogens among Patients with COVID-19. Microbiology spectrum 2021.9(1):00163-21.

Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, Hu T, Li J, Zhou X, Ren B. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020 Sep;104(18):7777-7785.

Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia (Nathan). 2021 Apr 25;13(1):5.

Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021 Jan;27(1):83-88.

Rothe K, Feihl S, Schneider J, Wallnöfer F, Wurst M, Lukas M et al.Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship. Eur J Clin Microbiol Infect Dis. 2021 Apr;40(4):859-869.

WHO/2019-nCoV/Surveillance_ Case_ Definition/2020.2

Forbes Betty A. Sahm Daniel F, Weissfield Alice S, Bailey and Scott’s Diagnostic Microbiology.12th ed. St.Louis, Missouri 63146:Mosby Elsevier;2007: pgs 93-119 .187-214.

Karaba SM, Jones G, Helsel T, Smith LL, Avery R, Dzintars K et al.Prevalence of Co-infection at the Time of Hospital Admission in COVID-19 Patients, A Multicenter Study. Open Forum Infect Dis. 2020 Dec 21;8(1)

Rawson T.M., Moore L.S.P., Zhu N., Ranganathan N., Skolimowska K., Gilchrist M. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020 .

Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, Peng Z, Pan H. 2020. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol 127:104364.

Jing R, Vunnam RR, Schnaubelt E, Vokoun C, Cushman-Vokoun A, Goldner D, Vunnam SR. Co-infection of COVID-19 and influenza A in a hemodialysis patient: a case report. BMC Infect Dis. 2021;21:68.

Contou D, Claudinon A, Pajot O, Micaëlo M, Longuet Flandre P, Dubert M, Cally R, Logre E, Fraissé M, Mentec H, Plantefève G. Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU. Ann Intensive Care. 2020 Sep 7;10(1):119.

Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, Peng Z, Pan H. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. China. J Clinical Virol 2020;127:104364.

Mohapatra RK, Dhama K, Mishra S, Sarangi AK, Kandi V, Tiwari R et al.The microbiota-related coinfections in COVID-19 patients: a real challenge. J Basic Appl Sci. 2021;10(1):47. doi: 10.1186/s43088-021-00134-7.

Mirzaei R, Goodarzi P, Asadi M, Soltani A, Aljanabi HAA, Jeda AS et al.Bacterial co-infections with SARS-CoV-2. International Union of Biochemistry and Molecular Biology. 2020 Oct;72(10):2097-2111.

Sharifipour E, Shams S, Esmkhani M, Khodadadi J, Fotouhi-Ardakani R, Koohpaei A, Doosti Z, Golzari SEJ. 2020. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis 20:646.

Lai CC, Wang CY, Hsueh PR. 2020. Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents? J Microbiol Immunol Infect 53:505–512.

Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J et al.2020. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020323:1488–1494.

Fontana C, Favaro M, Minelli S, Bossa MC, Altieri A. Co-infections observed in SARS-CoV-2 positive patients using a rapid diagnostic test. Sci Rep. 2021 Aug 11;11(1):16355.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513.

Gu J, Korteweg C. Pathology and pathogenesis of severe acute respiratory syndrome. Am J Pathol. 2007;170(4):1136–1147.

Downloads

Published

10-08-2022

How to Cite

1.
Cherian S, Jangla SM, Naidu R. Co-infection at the Time of Hospital Admission in Patients with COVID-19 Infection. Ann of Pathol and Lab Med [Internet]. 2022 Aug. 10 [cited 2024 Nov. 19];9(7):A132-138. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3170

Issue

Section

Original Article