Opportunistic Infections in COVID-19: A Systematic Review and Meta-Analysis.

• Authors: Nithin Kurra, University of Nebraska Medical Center; PI Woodard, Volgograd State Medical University; N Gandrakota, Emory University; H Gandhi, Manipal Academy of Higher Education; SR Polisetty, Manipal Academy of Higher Education; SP Ang, International Medical University; KP Patel, Smt. B. K. Shah Medical Institute & Research Centre; V Chitimalla, Shri B M Patil Medical College Hospital and Research Centre, Bijapur Lingayat District Educational (BLDE) University; MM Ali Baig, Dow University of Health Sciences; G Samudrala, National Board of Examinations, New Delhi
• Journal Title: Cureus
• Volume: Volume 14, Number 3
• Publisher: (publisher) | 2022-03, Pages e23687-e23687
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7759/cureus.23687
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology
• Keywords: bacterial coinfection in covid-19; coronavirus-associated pulmonary aspergillosis; covid-19; covid-19 co-infection; opportunistic fungal infection; opportunistic infections; respiratory coinfections; sars-cov-2; secondary infections; superinfections

Abstract

The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible studies were identified using PubMed/Medline since inception to June 25, 2021. Studies meeting the inclusion criteria were selected. Statistical analysis was conducted in Review Manager 5.4.1. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported as inverse variance and the corresponding 95% confidence interval. We screened 701 articles comprising 22 cohort studies which were included for analysis. The pooled prevalence of opportunistic infections/secondary infections/superinfections was 16% in COVID-19 patients. The highest prevalence of secondary infections was observed among viruses at 33%, followed by bacteria at 16%, fungi at 6%, and 25% among the miscellaneous group/wrong outcome. Opportunistic infections are more prevalent in critically ill patients. The isolated pathogens included Epstein-Barr virus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Hemophilus influenza, and invasive pulmonary aspergillosis. Large-scale studies are required to better identify opportunistic/secondary/superinfections in COVID-19 patients.