Khodavaisy Sadegh, Sarrafnia Haleh, Abdollahi Alireza
Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Research center for antibiotic stewardship and antimicrobial resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Pathol. 2024 Spring;19(2):136-147. doi: 10.30699/IJP.2024.2010087.3160. Epub 2024 Feb 15.
BACKGROUND & OBJECTIVE: Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies.
To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization.
We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality.
This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.
真菌合并感染会增加病毒性呼吸道感染的发病率和死亡率。本研究系统回顾并进行荟萃分析，以评估新冠病毒感染患者合并真菌感染的患病率。目的是简要概述这些感染对患者预后的影响，尤其是与死亡风险的关联，为未来研究提供参考并优化患者管理策略。
为识别关于新冠病毒感染患者的相关研究，我们对截至2023年7月的数据库进行了系统检索，包括真菌合并感染、死亡率和后遗症。使用PICO框架制定纳入标准，由两位作者分别采用标准技术进行数据提取。使用相关性模型进行统计分析，并用I²检验评估研究间的差异。使用R和RStudio进行统计分析和可视化。
我们最初识别出6764项研究，在检查等效性和一致性后，最终分析纳入了41项研究。因真菌感染死亡的新冠病毒感染患者的总体比值比为2.65，这表明同时感染新冠病毒和真菌的患者比仅感染新冠病毒的患者死亡风险更高。具体而言，新冠病毒相关肺曲霉病（CAPA）的比值比更高，为3.36，而新冠病毒相关念珠菌病（CAC）的比值比为1.84，两者都与死亡密切相关。然而，该真菌与其他真菌物种的合并感染在死亡风险上未显示出显著差异。
本研究确定CAPA和CAC是医疗环境中最常见的感染。真菌合并感染可能与新冠病毒感染患者死亡风险增加有关。
