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

Lansbury, Louise; Lim, Benjamin; Baskaran, Vadsala; Lim, Wei Shen

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, I2=92∙2%). A higher proportion of ICU patients had bacterial co-infections than patients in mixed ward/ICU settings (14%, 95% CI 5-26, I2=74∙7% versus 4%, 95% CI 1-9, I2= 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, I2=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.

Citation

Lansbury, L., Lim, B., Baskaran, V., & Lim, W. S. (2020). Co-infections in people with COVID-19: a systematic review and meta-analysis. Journal of Infection, 81(2), 266-275. https://doi.org/10.1016/j.jinf.2020.05.046

• Journal Article Type: Article
• Acceptance Date: May 23, 2020
• Online Publication Date: May 27, 2020
• Publication Date: 2020-08
• Deposit Date: May 27, 2020
• Publicly Available Date: May 28, 2021
• Journal: Journal of Infection
• Print ISSN: 0163-4453
• Electronic ISSN: 1532-2742
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 81
• Issue: 2
• Pages: 266-275
• DOI: https://doi.org/10.1016/j.jinf.2020.05.046
• Keywords: Coronavirus, COVID-19, Coinfection, Meta-Analysis
• Public URL: https://nottingham-repository.worktribe.com/output/4517038
• Publisher URL: https://www.journalofinfection.com/article/S0163-4453(20)30323-6/