3.3 X more likely to die if infected with SARS-Cov-2 plus a second pathogen – meta-analysis

Created November 2021

Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis

PLOS X https://doi.org/10.1371/journal.pone.0251170

Jackson S. Musuuza, Lauren Watson, Vishala Parmasad, Nathan Putman-Buehler, Leslie Christensen, Nasia Safdar

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Note Many of the pathogens are associated with low vitamin D:
Examples: acinetobacter, human influenza A, Aklebsiella pneumoniae

Other major risk factors in COVID-19 mortality are cormorbidities,     all of which are associated with low vitamin D * 26 health factors increase the risk of COVID-19 – all are proxies for low vitamin D * *Vitamin D thus    1) Prevents and treats COVID    2) Prevents and treats many all comorbities    3) Prevents many of the co-infections* * The study on this page was cited by The Double-Whammy COVID-Flu Atlantic Nov 2021 * "Some researchers have estimated that all told, as many as half of all COVID-19 deaths can be attributed to mixed infections, although others put the number considerably lower"

Introduction

The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either

  • at the time of a SARS-CoV-2 infection diagnosis (co-infection) or

  • subsequently (superinfection) .

However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection.

Patients and methods

We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763.

Results

Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of

  • co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of

  • superinfection was 24% (95% CI: 19%-30%).

Pooled prevalence of pathogen type stratified by co- or superinfection were:

  • viral co-infections, 10% (95% CI: 6%-14%);

    • viral superinfections, 4% (95% CI: 0%-10%);

  • bacterial co-infections, 8% (95% CI: 5%-11%);

    • bacterial superinfections, 20% (95% CI: 13%-28%);

  • fungal co-infections, 4% (95% CI: 2%-7%); and

    • fungal superinfections, 8% (95% CI: 4%-13%).

Patients with a co-infection or superinfection had higher odds of dying than those who only had SARS-CoV-2 infection (odds ratio = 3.31 , 95% CI: 1.82–5.99). Compared to those with co-infections, patients with superinfections had a higher prevalence of mechanical ventilation (45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]), but patients with co-infections had a greater average length of hospital stay than those with superinfections (mean = 29.0 days, standard deviation [SD] = 6.7 vs. mean = 16 days, SD = 6.2, respectively).

Conclusions

Our study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. The presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. Our findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.

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Tags: Virus