新型冠状病毒肺炎患者合并细菌、真菌及呼吸道病毒感染：一项系统评价与Meta分析

Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis.

作者信息

Alhumaid Saad, Al Mutair Abbas, Al Alawi Zainab, Alshawi Abeer M, Alomran Salamah A, Almuhanna Mohammed S, Almuslim Anwar A, Bu Shafia Ahmed H, Alotaibi Abdullah M, Ahmed Gasmelseed Y, Rabaan Ali A, Al-Tawfiq Jaffar A, Al-Omari Awad

机构信息

Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia.

Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia.

出版信息

Pathogens. 2021 Jun 25;10(7):809. doi: 10.3390/pathogens10070809.

DOI:10.3390/pathogens10070809

PMID:34202114

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8308492/

Abstract

BACKGROUND

Coinfection with bacteria, fungi, and respiratory viruses in SARS-CoV-2 is of particular importance due to the possibility of increased morbidity and mortality. In this meta-analysis, we calculated the prevalence of such coinfections.

METHODS

Electronic databases were searched from 1 December 2019 to 31 March 2021. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses.

RESULTS

Of the 6189 papers that were identified, 72 articles were included in the systematic review (40 case series and 32 cohort studies) and 68 articles (38 case series and 30 cohort studies) were included in the meta-analysis. Of the 31,953 SARS-CoV-2 patients included in the meta-analysis, the overall pooled proportion who had a laboratory-confirmed bacterial infection was 15.9% (95% CI 13.6-18.2, n = 1940, 49 studies, = 99%, 0.00001), while 3.7% (95% CI 2.6-4.8, n = 177, 16 studies, = 93%, 0.00001) had fungal infections and 6.6% (95% CI 5.5-7.6, n = 737, 44 studies, = 96%, 0.00001) had other respiratory viruses. SARS-CoV-2 patients in the ICU had higher co-infections compared to ICU and non-ICU patients as follows: bacterial (22.2%, 95% CI 16.1-28.4, = 88% versus 14.8%, 95% CI 12.4-17.3, = 99%), and fungal (9.6%, 95% CI 6.8-12.4, = 74% versus 2.7%, 95% CI 0.0-3.8, = 95%); however, there was an identical other respiratory viral co-infection proportion between all SARS-CoV-2 patients [(ICU and non-ICU) and the ICU only] (6.6%, 95% CI 0.0-11.3, = 58% versus 6.6%, 95% CI 5.5-7.7, = 96%). Funnel plots for possible publication bias for the pooled effect sizes of the prevalence of coinfections was asymmetrical on visual inspection, and Egger's tests confirmed asymmetry ( values < 0.05).

CONCLUSION

Bacterial co-infection is relatively high in hospitalized patients with SARS-CoV-2, with little evidence of playing a major role. Knowledge of the prevalence and type of co-infections in SARS-CoV-2 patients may have diagnostic and management implications.

摘要

背景

由于感染新型冠状病毒肺炎（SARS-CoV-2）的患者合并细菌、真菌及呼吸道病毒感染可能会增加发病率和死亡率，因此这种合并感染尤为重要。在本荟萃分析中，我们计算了此类合并感染的患病率。

方法

检索了2019年12月1日至2021年3月31日的电子数据库。患病率的效应量合并为95%置信区间（CI）。为尽量减少异质性，我们进行了亚组分析。

结果

在检索到的6189篇论文中，72篇文章纳入了系统评价（40篇病例系列研究和32篇队列研究），68篇文章（38篇病例系列研究和30篇队列研究）纳入了荟萃分析。在纳入荟萃分析的31953例SARS-CoV-2患者中，实验室确诊合并细菌感染的总体合并比例为15.9%（95%CI 13.6-18.2，n = 1940，49项研究，I² = 99%，P < 0.00001），合并真菌感染的比例为3.7%（95%CI 2.6-4.8，n = 177，16项研究，I² = 93%，P < 0.00001），合并其他呼吸道病毒感染的比例为6.6%（95%CI 5.5-7.6，n = 737，44项研究，I² = 96%，P < 0.00001）。与非重症监护病房（ICU）患者相比，ICU中的SARS-CoV-2患者合并感染率更高，如下所示：细菌感染（22.2%，95%CI 16.1-28.4，I² = 88% 对比14.8%，95%CI 12.4-17.3，I² = 99%），真菌感染（9.6%，95%CI 6.8-12.4，I² = 74% 对比2.7%，95%CI 0.0-3.8，I² = 95%）；然而，所有SARS-CoV-2患者（包括ICU和非ICU患者以及仅ICU患者）的其他呼吸道病毒合并感染比例相同（6.6%，95%CI 0.0-11.3，I² = 58% 对比6.6%，95%CI 5.5-7.7，I² = 96%）。合并感染患病率的效应量的漏斗图在视觉检查时不对称，Egger检验证实了不对称性（P值<0.05）。