A systematic review and meta-analysis of the epidemiology of bacterial and fungal coinfections among patients with SARS-CoV-2 infection

Mehta, Shivani

Full Metadata

Overview

Year:: 2021
Contributor:: Mehta, Shivani (creator); Jamieson, Amanda (Reader); Saldanha, Ian (Advisor); Brown University. School of Public Health (sponsor)
Genre:: theses
Subject:: Epidemiology; Public health; Coronavirus infections
Extent:: , None p.

Files

Description

Abstract:: Background: Bacterial and fungal infections, generally common in critically ill patients with viral respiratory infections, may be common in patients with SARS-CoV-2 (the virus causing COVID-19). Objective: We systematic reviewed the incidence, prevalence, and potential risk factors for bacterial and fungal coinfections among adults with SARS-CoV-2 infection. Methods: We searched Medline, Embase, and preprint servers (BioRxiv and MedRxiv) for relevant comparative or single-group studies as of September 2, 2020. We scanned the references of related systematic and rapid reviews. We evaluated each study for risk of bias (RoB) using standard methods. We conducted meta-analyses using random-effects models and assessed heterogeneity using the I2 statistic. Results: We screened 14,172 citations. Forty studies (33 published) comprising 19,749 patients met criteria. Most studies (14/40; 35%) were from China; others were from North America, Europe, and the Middle East. Most studies were in hospitals (39/40; 98%), and one was in a nursing home. We rated 4/5 comparative studies at high RoB and 1/5 at moderate RoB, and all 25 single-group studies at high RoB. Bacterial coinfection incidence ranged from 0 to 43% and prevalence 0 to 92%. From a meta-analysis of 704 patients, incidence of Streptococcus pneumoniae was 1.7% (95% CI 0.8–3.9%; I2 =45%; 3 studies). Mycoplasma pneumoniae incidence ranged from 0.1 to 9.8% and Chlamydia pneumoniae 0.1 to 8.4%. Fungal coinfection incidence ranged from 0.3 to 28% and prevalence 2.7 to 23%. Incidence of Aspergillus spp. ranged from 1.4 to 28%. Incidence of Candida spp. was 0.8% (95% CI 0.3–2.6%; I2=70%; 4 studies). Bacterial or fungal coinfection incidence ranged from 3.6 to 42%, and prevalence 5.6 to 24%. Due to sparsity of the evidence, we could evaluate potential risk factors for the category of either bacterial or fungal coinfection, but not for each individually. Among older patients (≥60 years), incidence of bacterial or fungal coinfection was 28% (95% CI 10–58%; I2 =61%; 3 studies). Among patients with chronic obstructive pulmonary disorder (COPD), incidence was 16% (95% CI 11–23%; I2 =0%; 5 studies) and prevalence 12% (95% CI 6–21%; I2 =0%; 3 studies). Among patients with diabetes, incidence ranged from 10 to 89% and prevalence 23 to 52%. Among patients with malignancies, incidence was 7% (95% CI 2–17%; I2 =0%; 3 studies). Among patients with hypertension, incidence ranged from 14 to 83% and prevalence 18 to 88%. Among patients mechanically ventilated due to COVID-19, prevalence was 37.4% (95% CI 29–47%; I2 =0%; 3 studies). Among severe/critical/ICU-admitted patients, incidence ranged from 11 to 75% and prevalence 12 to 100%. Among mild/moderate/non-ICU-admitted patients, incidence ranged from 1 to 48% and prevalence 13 to 100%. Conclusions: This analysis summarizes available data on the incidence and prevalence of bacterial and fungal coinfections among patients with SARS-CoV-2 infection, most of whom were hospitalized. Due to sparsity of evidence, evaluation of potential risk factors for specific pathogens was not feasible. Bacterial and fungal coinfections deserve attention in patients with SARS-CoV-2, particularly those with chronic conditions, such as COPD, and those mechanically ventilated.
Notes:: Thesis (M. P. H.)--Brown University, 2021

Content

Access Conditions

Rights: In Copyright

Citation

Mehta, Shivani, "A systematic review and meta-analysis of the epidemiology of bacterial and fungal coinfections among patients with SARS-CoV-2 infection" (2021). Public Health Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:7t8epgs9/

Relations

Collection:

Public Health Theses and Dissertations

Theses and Dissertations for the Public Health department.
...