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Co-infections in people with COVID-19: a systematic review and meta-analysis

Louise Lansbury1, Benjamin Lim2, Vadsala Baskaran3

  • 1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.

The Journal of Infection
|May 31, 2020
PubMed

Insights

Bacterial co-infections were found in 7% of hospitalized COVID-19 patients, which is lower than in past influenza pandemics. This suggests routine antibiotic use is not supported for COVID-19 management.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Epidemiology

Background:

  • Bacterial co-infections significantly contributed to mortality during previous influenza pandemics.
  • Understanding the prevalence of co-infections in COVID-19 patients is crucial for effective clinical management.

Purpose of the Study:

  • To evaluate the burden of bacterial, fungal, and viral co-infections in patients diagnosed with COVID-19.
  • To compare the prevalence of co-infections in COVID-19 with historical data from influenza pandemics.

Main Methods:

  • Systematic literature search of Embase, Medline, Cochrane Library, LILACS, and CINAHL databases.
  • Inclusion of studies published between January 1, 2020, and April 17, 2020, encompassing all patient ages and settings.
  • Primary outcome: pooled proportion of patients with bacterial, fungal, or viral co-infections.

Main Results:

  • Thirty studies involving 3834 patients revealed a 7% prevalence of bacterial co-infections in hospitalized COVID-19 patients.
  • Intensive Care Unit (ICU) patients exhibited a higher rate of bacterial co-infections (14%) compared to mixed ward/ICU settings (4%).
  • Common bacterial co-infections included Mycoplasma pneumonia, Pseudomonas aeruginosa, and Haemophilus influenzae; viral co-infections were 3%, primarily Respiratory Syncytial Virus and influenza A.

Conclusions:

  • The proportion of bacterial co-infections in COVID-19 patients is low, particularly when compared to previous influenza pandemics.
  • Findings do not support the routine administration of antibiotics for managing confirmed COVID-19 cases.
  • Further research into specific co-infections and their impact on COVID-19 outcomes is warranted.
Abstract

Keywords:
COVID-19CoinfectionCoronavirusMeta-Analysis

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