Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul:113:145-154.
doi: 10.1016/j.jhin.2021.04.001. Epub 2021 Apr 20.

Fungal and bacterial coinfections increase mortality of severely ill COVID-19 patients

D L Silva  1 , C M Lima  1 , V C R Magalhães  2 , L M Baltazar  1 , N T A Peres  1 , R B Caligiorne  3 , A S Moura  4 , T Fereguetti  5 , J C Martins  5 , L F Rabelo  5 , J S Abrahão  1 , A C Lyon  5 , S Johann  1 , D A Santos  6
Affiliations

Fungal and bacterial coinfections increase mortality of severely ill COVID-19 patients

D L Silva et al. J Hosp Infect. 2021 Jul.

Abstract

Background: SARS-CoV-2 predisposes patients to secondary infections; however, a better understanding of the impact of coinfections on the outcome of hospitalized COVID-19 patients is still necessary.

Aim: To analyse death risk due to coinfections in COVID-19 patients.

Methods: The odds of death of 212 severely ill COVID-19 patients were evaluated, with detailed focus on the risks for each pathogen, site of infection, comorbidities and length of hospitalization.

Findings: The mortality rate was 50.47%. Fungal and/or bacterial isolation occurred in 89 patients, of whom 83.14% died. Coinfected patients stayed hospitalized longer and had an increased odds of dying (odds ratio (OR): 13.45; R2 = 0.31). The risk of death was increased by bacterial (OR: 11.28) and fungal (OR: 5.97) coinfections, with increased levels of creatinine, leucocytes, urea and C-reactive protein. Coinfections increased the risk of death if patients suffered from cardiovascular disease (OR: 11.53), diabetes (OR: 6.00) or obesity (OR: 5.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for coagulase-negative Staphylococcus (OR: 25.39), Candida non-albicans (OR: 11.12), S. aureus (OR: 10.72), Acinetobacter spp. (OR: 6.88), Pseudomonas spp. (OR: 4.77), and C. albicans (OR: 3.97). The high-risk sites of infection were blood, tracheal aspirate, and urine. Patients with coinfection undergoing invasive mechanical ventilation were 3.8 times more likely to die than those without positive cultures.

Conclusion: Severe COVID-19 patients with secondary coinfections required longer hospitalization and had higher risk of death. The early diagnosis of coinfections is essential to identify high-risk patients and to determine the right interventions to reduce mortality.

Keywords: Bacterial; COVID-19; Coinfections; Fungal; Mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Demographics and clinical characteristics of hospitalized COVID-19 patients. Comparative analyses of COVID-19 case fatality rates by sex (A), age range (B), comorbidities and lifestyle (C), symptoms (D), invasive ventilation (E), and presence or absence of fungal and/or bacterial coinfections (F). The values in parentheses indicate the number of occurrences in the respective category. All relative frequency values are expressed as a percentage of the study cohort (N = 212). ∗P < 0.05 according to the logistic regression analysis. COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus.
Figure 2
Figure 2
Length of hospitalization period. Hospitalization (days) for patients who were discharged or who died (A) and for the presence or absence of fungal and/or bacterial coinfections (B). P-values calculated by Mann–Whitney U-test.
See this image and copyright information in PMC

References

    1. World Health Organization. WHO coronavirus disease (COVID-19) dashboard. Available at: https://covid19.who.int/[last accessed March 2021].
    1. Stasi C., Fallani S., Voller V., Silvestri C. Treatment for COVID-19: an overview. Eur J Pharmacol. 2020;889:173644. doi: 10.1016/j.ejphar.2020.173644. - DOI - PMC - PubMed
    1. Lansbury L., Lim B., Baskaran V., Lim W.S. Coinfections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81:266–275. doi: 10.1016/j.jinf.2020.05.046. - DOI - PMC - PubMed
    1. Wu C., Chen X., Cai Y., Xia J., Zhou X., Xu S., et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934–943. https://doi:10.1001/jamainternmed.2020.0994 - DOI - PMC - PubMed
    1. Cauley L.S., Vella A.T. Why is coinfection with influenza virus and bacteria so difficult to control? Discov Med. 2015;19:33–40. - PMC - PubMed