Feldman Charles, Anderson Ronald
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Pneumonia (Nathan). 2021 Apr 25;13(1):5. doi: 10.1186/s41479-021-00083-w.
It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. However, it is still unclear what exact roles co-infections and/or superinfections play in patients with COVID-19 infection.
This was an extensive review of the current literature regarding co-infections and superinfections in patients with SARS-CoV-2 infection. The definitions used were those of the Centers for Disease Control and Prevention (US), which defines coinfection as one occurring concurrently with the initial infection, while superinfections are those infections that follow on a previous infection, especially when caused by microorganisms that are resistant, or have become resistant, to the antibiotics used earlier. Some researchers have envisioned three potential scenarios of bacterial/SARS-CoV-2 co-infection; namely, secondary SARS-CoV-2 infection following bacterial infection or colonisation, combined viral/bacterial pneumonia, or secondary bacterial superinfection following SARS-CoV-2. There are a myriad of published articles ranging from letters to the editor to systematic reviews and meta-analyses describing varying ranges of co-infection and/or superinfection in patients with COVID-19. The concomitant infections described included other respiratory viruses, bacteria, including mycobacteria, fungi, as well as other, more unusual, pathogens. However, as will be seen in this review, there is often not a clear distinction made in the literature as to what the authors are referring to, whether true concomitant/co-infections or superinfections. In addition, possible mechanisms of the interactions between viral infections, including SARS-CoV-2, and other infections, particularly bacterial infections are discussed further. Lastly, the impact of these co-infections and superinfections in the severity of COVID-19 infections and their outcome is also described.
The current review describes varying rates of co-infections and/or superinfections in patients with COVID-19 infections, although often a clear distinction between the two is not clear in the literature. When they occur, these infections appear to be associated with both severity of COVID-19 as well as poorer outcomes.
在相当长的一段时间里，人们已经认识到病毒性呼吸道感染会使患者易患细菌感染，并且这些合并感染的后果比单独任何一种感染都更严重。然而，目前仍不清楚合并感染和/或重叠感染在新型冠状病毒肺炎（COVID-19）感染患者中的确切作用。
这是一篇对当前关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者合并感染和重叠感染的文献进行的广泛综述。所使用的定义来自美国疾病控制与预防中心，该中心将合并感染定义为与初始感染同时发生的感染，而重叠感染是指在先前感染之后发生的感染，尤其是由对先前使用的抗生素耐药或已产生耐药性的微生物引起的感染。一些研究人员设想了细菌/SARS-CoV-2合并感染的三种潜在情况；即细菌感染或定植后的继发性SARS-CoV-2感染、病毒性/细菌性混合肺炎、或SARS-CoV-2感染后的继发性细菌重叠感染。有大量已发表的文章，从给编辑的信到系统评价和荟萃分析，描述了COVID-19患者不同程度的合并感染和/或重叠感染。所描述的伴随感染包括其他呼吸道病毒、细菌（包括分枝杆菌）、真菌以及其他更罕见的病原体。然而，正如在本综述中将看到的，文献中作者所指的内容往往没有明确区分，无论是真正的伴随/合并感染还是重叠感染。此外，还进一步讨论了包括SARS-CoV-2在内的病毒感染与其他感染（特别是细菌感染）之间相互作用的可能机制。最后，还描述了这些合并感染和重叠感染对COVID-19感染严重程度及其结局的影响。
当前的综述描述了COVID-19感染患者中合并感染和/或重叠感染的不同发生率，尽管文献中这两者之间往往没有明确区分。当这些感染发生时，它们似乎与COVID-19的严重程度以及更差的结局都有关。
