Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?

• Published in: Journal of microbiology, immunology and infection Vol. 53; no. 4; pp. 505 - 512
• Main Authors: Lai, Chih-Cheng, Wang, Cheng-Yi, Hsueh, Po-Ren
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.08.2020; Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC; Elsevier
• Subjects: Anti-Infective Agents - therapeutic use; Betacoronavirus - isolation & purification; Clinical Laboratory Techniques; Co-infection; Coinfection - diagnosis; Coinfection - drug therapy; Coinfection - epidemiology; Coronavirus Infections - diagnosis; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; COVID-19; COVID-19 Testing; COVID-19 Vaccines; Drug Therapy, Combination; Humans; Influenza viruses; Pandemics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - drug therapy; Pneumonia, Viral - epidemiology; Practice Guidelines as Topic; Reagent Kits, Diagnostic; SARS-CoV-2; COVID-19; Influenza viruses; SARS-CoV-2; Co-infection
• ISSN: 1684-1182; 1995-9133; 1995-9133
• DOI: 10.1016/j.jmii.2020.05.013

Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus. Influenza A was one of the most common co-infective viruses, which may have caused initial false-negative results of real-time reverse-transcriptase polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratory and imaging findings alone cannot help distinguish co-infection from SARS-CoV-2 infection. Newly developed syndromic multiplex panels that incorporate SARS-CoV-2 may facilitate the early detection of co-infection among COVID-19 patients. By contrast, clinicians cannot rule out SARS-CoV-2 infection by ruling in other respiratory pathogens through old syndromic multiplex panels at this stage of the COVID-19 pandemic. Therefore, clinicians must have a high index of suspicion for coinfection among COVID-19 patients. Clinicians can neither rule out other co-infections caused by respiratory pathogens by diagnosing SARS-CoV-2 infection nor rule out COVID-19 by detection of non-SARS-CoV-2 respiratory pathogens. After recognizing the possible pathogens causing co-infection among COVID-19 patients, appropriate antimicrobial agents can be recommended.