Co-infections in people with COVID-19: a systematic review and meta-analysis

Highlights

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  SARS-CoV-2, the cause of COVID19 disease, has spread globally since late 2019

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  Bacterial coinfections associated with mortality in previous influenza pandemics

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  Proportion of COVID19 patients with bacterial coinfection less than in flu pandemics

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  Higher proportion of critically-ill with bacterial coinfections than in mixed setting

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  Bacterial co-pathogen profiles different to those in influenza co-infections

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  Fungal coinfection diagnosis difficult so high level suspicion in critically-ill

Abstract

Objectives

: In previous influenza pandemics, bacterial co-infections have been a major cause of mortality. We aimed to evaluate the burden of co-infections in patients with COVID-19.

Methods

: We systematically searched Embase, Medline, Cochrane Library, LILACS and CINAHL for eligible studies published from 1 January 2020 to 17 April 2020. We included patients of all ages, in all settings. The main outcome was the proportion of patients with a bacterial, fungal or viral co-infection. .

Results

: Thirty studies including 3834 patients were included. Overall, 7% of hospitalised COVID-19 patients had a bacterial co-infection (95% CI 3-12%, n=2183, I ²=92∙2%). A higher proportion of ICU patients had bacterial co-infections than patients in mixed ward/ICU settings (14%, 95% CI 5-26, I ²=74∙7% versus 4%, 95% CI 1-9, I ²= 91∙7%). The commonest bacteria were Mycoplasma pneumonia, Pseudomonas aeruginosa and Haemophilus influenzae. The pooled proportion with a viral co-infection was 3% (95% CI 1-6, n=1014, I ²=62∙3%), with Respiratory Syncytial Virus and influenza A the commonest. Three studies reported fungal co-infections.

Conclusions

: A low proportion of COVID-19 patients have a bacterial co-infection; less than in previous influenza pandemics. These findings do not support the routine use of antibiotics in the management of confirmed COVID-19 infection.