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Meta-Analysis
. 2022 Jan;36(1):e24151.
doi: 10.1002/jcla.24151. Epub 2021 Dec 1.

Worldwide prevalence of microbial agents' coinfection among COVID-19 patients: A comprehensive updated systematic review and meta-analysis

Reza Pakzad  1 , Pooneh Malekifar  2 , Zainab Shateri  3 , Milad Zandi  4   5 , Sara Akhavan Rezayat  6 , Maral Soleymani  7 , Mohammad Reza Karimi  5 , Seyed Esmaeil Ahmadi  8 , Ramin Shahbahrami  5 , Iraj Pakzad  9 , Fatemeh Abdi  10 , Abbas Farahani  11 , Saber Soltani  4   5 , Mina Mobini Kesheh  12 , Parastoo Hosseini  4
Affiliations
Meta-Analysis

Worldwide prevalence of microbial agents' coinfection among COVID-19 patients: A comprehensive updated systematic review and meta-analysis

Reza Pakzad et al. J Clin Lab Anal. 2022 Jan.

Abstract

Background: To provide information about pathogens' coinfection prevalence with SARS-CoV-2 could be a real help to save patients' lives. This study aims to evaluate the pathogens' coinfection prevalence among COVID-19 patients.

Method: In order to find all of the relevant articles, we used systematic search approach. Research-based databases including PubMed, Web of Science, Embase, and Scopus, without language restrictions, were searched to identify the relevant bacterial, fungal, and viral coinfections among COVID-19 cases from December 1, 2019, to August 23, 2021. In order to dig deeper, other scientific repositories such as Medrxiv were probed.

Results: A total of 13,023 studies were found through systematic search. After thorough analysis, only 64 studies with 61,547 patients were included in the study. The most common causative agents of coinfection among COVID-19 patients were bacteria (pooled prevalence: 20.97%; 95% CI: 15.95-26.46; I2 : 99.9%) and less frequent were virus coinfections (pooled prevalence: 12.58%; 95% CI: 7.31-18.96; I2 : 98.7%). The pooled prevalence of fungal coinfections was also 12.60% (95% CI: 7.84-17.36; I2 : 98.3%). Meta-regression analysis showed that the age sample size and WHO geographic region did not influenced heterogeneity.

Conclusion: We identified a high prevalence of pathogenic microorganism coinfection among COVID-19 patients. Because of this rate of coinfection empirical use of antibacterial, antifungal, and antiviral treatment are advisable specifically at the early stage of COVID-19 infection. We also suggest running simultaneously diagnostic tests to identify other microbiological agents' coinfection with SARS-CoV-2.

Keywords: COVID-19; coinfection; coronavirus; meta-analysis; systematic review.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

FIGURE 1
FIGURE 1
Study selection process based on PRISMA flow diagram
FIGURE 2
FIGURE 2
Prevalence of all‐type coinfections in patients with COVID‐19 Forest plot based on a random‐effects model. Each study identifies distinguished by their author (year) and countries. Each line segment's midpoint shows the prevalence estimate, length of line segment indicates 95% confidence interval (CI) in each study, and diamond mark illustrates the pooled estimate
FIGURE 3
FIGURE 3
Pooled prevalence with 95% confidence interval [CI] and heterogeneity indexes of coinfections in COVID‐19 patients based on type of the coinfections and different regional places. The diamond mark illustrates the pooled prevalence and the length of the diamond indicates the 95% CI
FIGURE 4
FIGURE 4
Association between prevalence of age (A) and sample size (B) with prevalence of coinfections by means of meta‐regression. The size of circles indicates the precision of each study. There is no significant association with respect to the prevalence of coinfections with age sample size
See this image and copyright information in PMC

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