Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study

• DOI: 10.1016/j.cmi.2020.07.041
• Publication Date: 2020-07-31T07:24:02Z
• Authors: Carolina Garcia-V...; Gemma Sanjuan; Estela Moreno-García; Pedro Puerta-Alcalde; Nicole Garcia-Pouton; Mariana Chumbita; Mariana Fernandez...; Cristina Pitart; Alexy Inciarte; Marta Bodro; Laura Morata; Juan Ambrosioni; Ignacio Grafia; Fernanda Meira; Irene Macaya; Celia Cardozo; Climent Casals; Adrian Tellez; Pedro Castro; Francesc Marco; Felipe García; Josep Mensa; José Antonio Mart...; Alex Soriano; Verónica Rico; Marta Hernández-M...; Daiana Agüero; Berta Torres; Ana González; Lorena de la Mora; Jhon Rojas; Laura Linares; Berta Fidalgo; Natalia Rodriguez; David Nicolas; Laia Albiach; José Muñoz; Alex Almuedo; Daniel Camprubí; Ma Angeles Marcos; Daniel Camprubí; Catia Cilloniz; Sara Fernández; Jose M. Nicolas; Antoni Torres
• Keywords: 2019-20 coronavirus outbreak

To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19).We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records.Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes.Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.