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. 2022 Jan 17;8(1):91.
doi: 10.3390/jof8010091.

Analysis of Fungal and Bacterial Co-Infections in Mortality Cases among Hospitalized Patients with COVID-19 in Taipei, Taiwan

De-En Lu  1 , Shih-Han Hung  2   3 , Ying-Shih Su  4 , Wen-Sen Lee  4   5
Affiliations

Analysis of Fungal and Bacterial Co-Infections in Mortality Cases among Hospitalized Patients with COVID-19 in Taipei, Taiwan

De-En Lu et al. J Fungi (Basel). .

Abstract

Fungal or bacterial co-infections in patients with H1N1 influenza have already been reported in many studies. However, information on the risk factors, complications, and prognosis of mortality cases with coronavirus disease 2019 (COVID-19) are limited. We aimed to assess 36 mortality cases of 178 hospitalized patients among 339 patients confirmed to have had SARS-CoV-2 infections in a medical center in the Wenshan District of Taipei, Taiwan, between January 2020 and September 2021. Of these 36 mortality cases, 20 (60%) were men, 28 (77.7%) were aged >65 years, and the median age was 76 (54-99) years. Comorbidities such as hypertension, coronary artery disease, and chronic kidney disease were more likely to be found in the group with length of stay (LOS) > 7 d. In addition, the laboratory data indicating elevated creatinine-phosphate-kinase (CPK) (p < 0.001) and lactic acid dehydrogenase (LDH) (p = 0.05), and low albumin (p < 0.01) levels were significantly related to poor prognosis and mortality. The respiratory pathogens of early co-infections (LOS < 7 d) in the rapid progression to death group (n = 7 patients) were two bacteria (22.2%) and seven Candida species (77.8.7%). In contrast, pathogens of late co-infections (LOS > 7 d) (n = 27 patients) were 20 bacterial (54.1%), 16 Candida (43.2%), and only 1 Aspergillus (2.7%) species. In conclusion, the risk factors related to COVID-19 mortality in the Wenshan District of Taipei, Taiwan, were old age, comorbidities, and abnormal biomarkers such as low albumin level and elevated CPK and LDH levels. Bacterial co-infections are more common with Gram-negative pathogens. However, fungal co-infections are relatively more common with Candida spp. than Aspergillus in mortality cases of COVID-19.

Keywords: COVID-19; bacterial infections; co-infections; fungal infections; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The Wenshan District (red color), located at the border of Taipei City and near the central mountain range (reference from Google Maps).
Figure 2
Figure 2
Epidemiology and age range of patients with COVID-19. COVID-19, Coronavirus disease 2019. LOS, length of stay (admission to mortality).
Figure 3
Figure 3
Distribution of respiratory pathogens in COVID-19 mortality cases. The biologic sample was aspirated from endo-tracheal aspirate. C. albicans was the most common co-infection. Solid line: <7 d length of stay (LOS); Dotted line: >7 d LOS.
See this image and copyright information in PMC

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