Bacterial co-infections with SARS-CoV-2

Abstract

The pandemic coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has affected millions of people worldwide. To date, there are no proven effective therapies for this virus. Efforts made to develop antiviral strategies for the treatment of COVID-19 are underway. Respiratory viral infections, such as influenza, predispose patients to co-infections and these lead to increased disease severity and mortality. Numerous types of antibiotics such as azithromycin have been employed for the prevention and treatment of bacterial co-infection and secondary bacterial infections in patients with a viral respiratory infection (e.g., SARS-CoV-2). Although antibiotics do not directly affect SARS-CoV-2, viral respiratory infections often result in bacterial pneumonia. It is possible that some patients die from bacterial co-infection rather than virus itself. To date, a considerable number of bacterial strains have been resistant to various antibiotics such as azithromycin, and the overuse could render those or other antibiotics even less effective. Therefore, bacterial co-infection and secondary bacterial infection are considered critical risk factors for the severity and mortality rates of COVID-19. Also, the antibiotic-resistant as a result of overusing must be considered. In this review, we will summarize the bacterial co-infection and secondary bacterial infection in some featured respiratory viral infections, especially COVID-19.

Keywords: COVID-19; SARS-CoV-2; antibiotic; bacterial co-infection; viral infection.

FIGURE 1

Postulated schematic of bacterial coinfection with SARS‐CoV‐2 infection. It has been proposed when SARS‐ CoV‐2 infects lung cells can damage the cells and the lung infrastructure. This situation attracts neutrophil and macrophages to the site of infection and promoting the inflammation. Finally, the changed situation and epithelial damage can cause bacteria to adhere to and invasion of the cells and proliferation. MQ, macrophage; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2