Department of Clinical Laboratory, Shenzhen Third People's Hospital, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.
Clin Respir J. 2021 Jul;15(7):815-825. doi: 10.1111/crj.13369. Epub 2021 Apr 19.
Co-infections, secondary bacterial or fungal infections, are important risk factors for poor outcomes in viral infections. The prevalence of co-infection and secondary infection in patients infected with SARS-CoV-2 is not well understood.
To investigate the role of co-infections and secondary infections in disease severity of hospitalized individuals with COVID-19.
A retrospective study was carried out between 11 January 2020 and 1 March 2020 among 408 laboratory confirmed COVID-19 patients in China. These patients were divided into three groups based on disease severity: mild or moderate, severe, or critically ill. Microbiological pathogens in blood, urine, and respiratory tract specimens were detected by the combination of culture, serology, polymerase chain reaction, and metagenomic next-generation sequencing (mNGS).
The median age of participants was 48 years (IQR 34-60 years). Fifty-two patients (12.7%) had at least one additional pathogen, 8.1% were co-infected, and 5.1% had a secondary infection. There were 13 Mycoplasma pneumoniae cases, 8 Haemophilus influenzae cases, 8 respiratory viruses, and 3 Streptococcus pneumoniae cases, primarily detected in mild and moderate COVID-19 patients. Hospital-acquired infection pathogens were more common in critically ill patients. Compared to those without additional pathogens, patients with co-infections and/or secondary infections were more likely to receive antibiotics (p < 0.001) and have elevated levels of d-dimer (p = 0.0012), interleukin-6 (p = 0.0027), and procalcitonin (p = 0.0002). The performance of conventional culture was comparable with that of mNGS in diagnosis of secondary infections.
Co-infections and secondary infections existed in hospitalized COVID-19 patients and were relevant to the disease severity. Screening of common respiratory pathogens and hospital infection control should be strengthened.
合并感染，即继发细菌或真菌感染，是导致病毒感染不良预后的重要危险因素。目前尚不清楚 SARS-CoV-2 感染患者合并感染和继发感染的发生率。
研究合并感染和继发感染在住院 COVID-19 患者疾病严重程度中的作用。
这是一项回顾性研究，于 2020 年 1 月 11 日至 3 月 1 日在中国进行，共纳入 408 例实验室确诊的 COVID-19 患者。这些患者根据疾病严重程度分为三组：轻症或普通型、重症和危重症。通过培养、血清学、聚合酶链反应和宏基因组下一代测序（mNGS）相结合的方法检测血液、尿液和呼吸道标本中的微生物病原体。
参与者的中位年龄为 48 岁（IQR 34-60 岁）。52 例（12.7%）至少合并感染一种其他病原体，8.1%为合并感染，5.1%为继发感染。有 13 例肺炎支原体病例、8 例流感嗜血杆菌病例、8 例呼吸道病毒病例和 3 例肺炎链球菌病例，主要见于轻症和普通型 COVID-19 患者。医院获得性感染病原体在危重症患者中更为常见。与无其他病原体的患者相比，合并感染和/或继发感染的患者更有可能接受抗生素治疗（p < 0.001），且 d-二聚体（p = 0.0012）、白细胞介素-6（p = 0.0027）和降钙素原（p = 0.0002）水平升高。传统培养在诊断继发感染方面的表现与 mNGS 相当。
住院 COVID-19 患者存在合并感染和继发感染，与疾病严重程度相关。应加强对常见呼吸道病原体的筛查和医院感染控制。
