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De Francesco MA, Piva S, Pellizzeri S, Signorini L, Fumarola B, Corbellini S, Piccinelli G, Simonetti F, Carta V, Mangeri L, Padovani M, Vecchiati D, Latronico N, Castelli F, Caruso A. Response to the Letter to the Editor on "Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS-CoV-2 infection than negative patients and are associated to a worse outcome". J Med Virol 2023; 95:e29192. [PMID: 37855669 DOI: 10.1002/jmv.29192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Maria Antonia De Francesco
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Universita degli Studi di Brescia Dipartimento Specialita Medico-Chirurgiche Scienze Radiologiche e Sanita Pubblica, Brescia, Italy
| | - Simone Pellizzeri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Liana Signorini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Benedetta Fumarola
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Francesca Simonetti
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Valentina Carta
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Lucia Mangeri
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Michela Padovani
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Daniela Vecchiati
- First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Universita degli Studi di Brescia Dipartimento Specialita Medico-Chirurgiche Scienze Radiologiche e Sanita Pubblica, Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
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De Francesco MA, Signorini L, Piva S, Pellizzeri S, Fumarola B, Corbellini S, Piccinelli G, Simonetti F, Carta V, Mangeri L, Padovani M, Vecchiati D, Latronico N, Castelli F, Caruso A. Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS CoV-2 infection than negative patients and are associated to a worse outcome. J Med Virol 2023; 95:e28892. [PMID: 37394790 DOI: 10.1002/jmv.28892] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
Patients with viral infections are at higher risk to acquire bacterial and fungal superinfections associated with a worse prognosis. We explored this critical point in the setting of patients with severe COVID-19 disease. The study included 1911 patients admitted to intensive care unit (ICU) during a 2-year study period (March 2020-March 2022). Of them, 713 (37.3%) were infected with SARS-CoV-2 and 1198 were negative (62.7%). Regression analysis was performed to determine risk factors associated with the presence of bacterial and/or fungal superinfections in SARS-CoV-2 patients and to evaluate predictors of ICU mortality. Of the 713 patients with SARS-CoV-2 infection, 473 (66.3%) had respiratory and/or bloodstream bacterial and/or fungal superinfections, while of the 1198 COVID-19-negative patients, only 369 (30%) showed respiratory and/or bloodstream bacterial and/or fungal superinfections (p < 0.0001). Baseline characteristics of COVID-19 patients included a median age of 66 (interquartile range [IQR], 58-73), a predominance of males (72.7%), and the presence of a BMI higher than 24 (median 26; IQR, 24.5-30.4). Seventy-four percent (527, 73.9%) had one or more comorbidities and 135 (18.9%) of them had received previous antibiotic therapy. Furthermore, most of them (473, 66.3%) exhibited severe radiological pictures and needed invasive mechanical ventilation. Multivariate logistic regression analysis showed that 1 unit increment in BMI rises the risk of bacterial and/or fungal superinfections acquisition by 3% and 1-day increment in ICU stays rises the risk of bacterial and/or fungal superinfections acquisition by 11%. Furthermore, 1-day increment in mechanical ventilation rises the risk of bacterial and/or fungal superinfection acquisition by 2.7 times. Furthermore, patients with both bacterial and fungal infections had a significantly higher mortality rate than patients without superinfections (45.8% vs. 26.2%, p < 0.0001). Therefore, bacterial and fungal superinfections are frequent in COVID-19 patients admitted to ICU and their presence is associated with a worse outcome. This is an important consideration for targeted therapies in critically ill SARS-CoV-2 infected patients to improve their clinical course.
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Affiliation(s)
- Maria Antonia De Francesco
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Liana Signorini
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Simone Pellizzeri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Benedetta Fumarola
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Francesca Simonetti
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Valentina Carta
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Lucia Mangeri
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Michela Padovani
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Daniela Vecchiati
- First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, Brescia, 25123, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy
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Scendoni R, Bury E, Lima Arrais Ribeiro I, Cingolani M, Cameriere R, De Benedictis A, De Micco F. Leading Pathogens Involved in Co-Infection and Super-Infection with COVID-19: Forensic Medicine Considerations after a Systematic Review and Meta-Analysis. Pathogens 2023; 12:pathogens12050646. [PMID: 37242315 DOI: 10.3390/pathogens12050646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
The COVID-19 pandemic raised concerns about the potential for co-infection or over-infection with other respiratory infections, as they can complicate the diagnosis, treatment and prognosis of the disease. This is also a challenge for forensic pathologists, who may come across cases where the presence of co-infection or over-infection is suspected or confirmed, and it is important that they take this into account when determining the cause of death. The aim of this systematic review is to analyse the prevalence of each specific pathogen co-infecting or over-infecting patients with SARS-CoV-2 infection. In total, 575 studies were selected from the Scopus and Pub-Med online databases and 8 studies were included in a meta-analysis. Male gender, advanced age and nursing home care are risk factors associated with the development of co-infection, whereas age, tachypnoea, hypoxaemia and bacterial infection are predictors of mortality. Overall, however, having a SARS-CoV-2 infection does not represent a real risk for the development of co-infections/super-infections.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, University of Macerata, 62100 Macerata, Italy
| | - Emanuele Bury
- Department of Law, University of Macerata, 62100 Macerata, Italy
| | | | | | - Roberto Cameriere
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy
| | - Francesco De Micco
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy
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Tsai YW, Tsai CF, Wu JY, Huang PY, Liu TH, Lai CC. The risk of methicillin-resistant Staphylococcus aureus infection following COVID-19 and influenza: A retrospective cohort study from the TriNetX network. J Infect 2023; 86:256-308. [PMID: 36632945 PMCID: PMC9867601 DOI: 10.1016/j.jinf.2023.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Ya-Wen Tsai
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Laboratory Sciences and Biotechnology, Fooyin University
| | - Chia-Fen Tsai
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ting-Hui Liu
- Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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The impact of the secondary infections in ICU patients affected by COVID-19 during three different phases of the SARS-CoV-2 pandemic. Clin Exp Med 2022:10.1007/s10238-022-00959-1. [PMID: 36459278 PMCID: PMC9717567 DOI: 10.1007/s10238-022-00959-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Microbial secondary infections can contribute to an increase in the risk of mortality in COVID-19 patients, particularly in case of severe diseases. In this study, we collected and evaluated the clinical, laboratory and microbiological data of COVID-19 critical ill patients requiring intensive care (ICU) to evaluate the significance and the prognostic value of these parameters. One hundred seventy-eight ICU patients with severe COVID-19, hospitalized at the S. Francesco Hospital of Nuoro (Italy) in the period from March 2020 to May 2021, were enrolled in this study. Clinical data and microbiological results were collected. Blood chemistry parameters, relative to three different time points, were analyzed through multivariate and univariate statistical approaches. Seventy-four percent of the ICU COVID-19 patients had a negative outcome, while 26% had a favorable prognosis. A correlation between the laboratory parameters and days of hospitalization of the patients was observed with significant differences between the two groups. Moreover, Staphylococcus aureus, Enterococcus faecalis, Candida spp, Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequently isolated microorganisms from all clinical specimens. Secondary infections play an important role in the clinical outcome. The analysis of the blood chemistry tests was found useful in monitoring the progression of COVID-19.
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Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes. Diagnostics (Basel) 2022; 12:diagnostics12071617. [PMID: 35885522 PMCID: PMC9323920 DOI: 10.3390/diagnostics12071617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Bacterial and fungal co-infections and superinfections have a critical role in the outcome of the COVID-19 patients admitted to the Intensive Care Unit (ICU). Methods: The present study is a retrospective analysis of 95 patients admitted to the ICU for COVID-19-related ARDS during the first (February−May 2020) and second waves of the pandemic (October 2020−January 2021). Demographic and clinical data, CT imaging features, and pulmonary and extra-pulmonary complications were recorded, as well as the temporal evolution of CT findings when more than one scan was available. The presence of co-infections and superinfections was registered, reporting the culprit pathogens and the specimen type for culture. A comparison between patients with and without bacterial and/or co-infections/superinfections was performed. Results: Sixty-three patients (66.3%) developed at least one confirmed co-infection/superinfection, with 52 (82.5%) developing pneumonia and 43 (68.3%) bloodstream infection. Gram-negative bacteria were the most common co-pathogens identified and Aspergillus spp. was the most frequent pulmonary microorganism. Consolidations, cavitations, and bronchiectasis were significantly associated with the presence of co-infections/superinfections (p = 0.009, p = 0.010 and p = 0.009, respectively); when considering only patients with pulmonary co-pathogens, only consolidations remained statistically significative (p = 0.004). Invasive pulmonary aspergillosis was significantly associated with the presence of cavitations and bronchiectasis (p < 0.001). Patients with co-infections/superinfections presented a significantly higher mortality rate compared to patients with COVID-19 only (52.4% vs. 25%, p = 0.016). Conclusions: Bacterial and fungal co-infections and superinfections are frequent in COVID-19 patients admitted to ICU and are associated with worse outcomes. Imaging plays an important role in monitoring critically ill COVID-19 patients and may help detect these complications, suggesting further laboratory investigations.
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