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. 2022 Oct;14(5):624-635.
doi: 10.18502/ijm.v14i5.10955.

Bacterial and fungal coinfections among patients with COVID-19 in Zanjan, Northwest of Iran; a single-center observational with meta-analysis of the literature

Hamid Morovati  1 , Saba Eslami  2 , Hesam Farzaneh Bonab  3 , Mohammad Kord  4 , Sima Darabian  3
Affiliations

Bacterial and fungal coinfections among patients with COVID-19 in Zanjan, Northwest of Iran; a single-center observational with meta-analysis of the literature

Hamid Morovati et al. Iran J Microbiol. 2022 Oct.

Abstract

Background and objectives: There is a poor understanding about the prevalence and characteristics of secondary bacterial and fungal infections among Coronavirus diseases 2019 (COVID-19) superinfection in hospitalized patients.

Materials and methods: Four hundred COVID-19-proven patients were enrolled in this study. Nasal swabs for molecular assay (Real-time PCR) and sputum samples for further microbiological assays were collected. Following a broad-spectrum search, a meta-analysis was performed using StatsDirect software (version 2.7.9) according to the DerSimonian and Laird method applying the random-effects models.

Results: Streptococcus spp. (21.5%) and Staphylococcus spp. (16.7%) had the highest prevalence of bacterial coinfection among the COVID-19 patients, while Acinetobacter spp. had the lowest prevalence (4.2%). Among fungal coinfections, Candida albicans was the most prevalent (6.7%), and Aspergillus spp. was the lowest (2%). Males, elderly patients, patients with a history of underlying diseases and drug use, patients who showed acute clinical symptoms, and patients with a prolonged hospital stay had a higher incidence of secondary infections (P-value <0.05). The pooled prevalence for bacterial and fungal coinfections was 33.52% (95% CI: 18.12 to 50.98; I2: 99.4%; P-value: <0.0001).

Conclusion: We suggest designing additional research with a larger target population and diagnostic molecular analyses to depict a more realistic view of the coinfection status.

Keywords: COVID-19; Nosocomial infection; Secondary infection.

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Figures

Fig. 1.
Fig. 1.
The flowchart of the study identification and selection process
Fig. 2.
Fig. 2.
Forest plot of the pooled prevalence of patients with COVID-19 and bacterial coinfections.
Fig. 3.
Fig. 3.
Funnel plot of the pooled prevalence of patients with COVID-19 and bacterial coinfections.
Fig. 4.
Fig. 4.
Forest plot of the pooled prevalence of patients with COVID-19 and fungal coinfections.
Fig. 5.
Fig. 5.
Funnel plot of the pooled prevalence of patients with COVID-19 and fungal coinfections.
Fig. 6.
Fig. 6.
Forest plot of the pooled prevalence of patients with COVID-19 and fungal and bacterial coinfections.
Fig. 7.
Fig. 7.
Funnel plot of the pooled prevalence of patients with COVID-19 and fungal and bacterial coinfections.
See this image and copyright information in PMC

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