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

Garcia-Vidal, Carolina; Sanjuan, Gemma; Moreno-García, Estela; Puerta-Alcalde, Pedro; Garcia-Pouton, Nicole; Chumbita, Mariana; Fernandez-Pittol, Mariana; Pitart, Cristina; Inciarte, Alexy; Bodro, Marta; Morata, Laura; Ambrosioni, Juan; Grafia, Ignacio; Meira, Fernanda; Macaya, Irene; Cardozo, Celia; Casals, Climent; Tellez, Adrian; Castro, Pedro; Marco, Francesc; García, Felipe; Mensa, Josep; Martínez, José Antonio; Soriano, Alex

OBJECTIVES: To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.