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. 2023 Jul 10;12(7):927.
doi: 10.3390/pathogens12070927.

Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia

Jochen Johannes Schoettler  1 , Stany Sandrio  1 , Christoph Boesing  1 , Lena Bauer  1 , Thomas Miethke  2   3 , Manfred Thiel  1   2 , Joerg Krebs  1
Affiliations

Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia

Jochen Johannes Schoettler et al. Pathogens. .

Abstract

Viral pneumonia is frequently complicated by bacterial co- or superinfection (c/s) with adverse effects on patients' outcomes. However, the incidence of c/s and its impact on the outcomes of patients might be dependent on the type of viral pneumonia. We performed a retrospective observational study in patients with confirmed COVID-19 pneumonia (CP) or influenza pneumonia (IP) from 01/2009 to 04/2022, investigating the incidence of c/s using a competing risk model and its impact on mortality in these patients in a tertiary referral center using multivariate logistic regressions. Co-infection was defined as pulmonary pathogenic bacteria confirmed in tracheal aspirate or bronchoalveolar lavage within 48 h after hospitalization. Superinfection was defined as pulmonary pathogenic bacteria detected in tracheal aspirate or bronchoalveolar lavage 48 h after hospitalization. We examined 114 patients with CP and 76 patients with IP. Pulmonary bacterial co-infection was detected in 15 (13.2%), and superinfection was detected in 50 (43.9%) of CP patients. A total of 5 (6.6%) co-infections (p = 0.2269) and 28 (36.8%) superinfections (p = 0.3687) were detected in IP patients. The overall incidence of c/s did not differ between CP and IP patients, and c/s was not an independent predictor for mortality in a study cohort with a high disease severity. We found a significantly higher probability of superinfection for patients with CP compared to patients with IP (p = 0.0017).

Keywords: COVID-19; SARS-CoV-2; acute respiratory distress syndrome; bacterial co- or superinfection; influenza; pneumonia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percentage increase from hospital admission to detection of pathogenic bacteria in patients with COVID-19- and influenza-associated pneumonia. Y-axis shows percentage increase in c/s detection in the studied cohort; X-axis displays days till detection of pathogenic bacteria. Blue line with circles represents CP patients; red line with boxes shows IP patients.
Figure 2
Figure 2
Time in days from hospital admission to detection of pathogenic bacteria in patients with COVID-19- and influenza-associated pneumonia. Y-axis shows total amount of pathogenic bacteria detected daily after ICU admission; X-axis displays days till detection of pathogenic bacteria. Blue bars represent CP patients; red bars show IP patients.
Figure 3
Figure 3
Cumulative incidence of superinfection over time for patients with COVID-19- or influenza-associated pneumonia. Mortality was regarded as a competing event. Blue solid line shows COVID-19-associated pneumonia patients, and red dashed line shows influenza-associated pneumonia patients.
See this image and copyright information in PMC

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