Co-infections: potentially lethal and unexplored in COVID-19
Michael J. Cox, Nicholas J. Loman, Debby Bogaert, Justin O’Grady
Abstract
Co-infections: potentially lethal and unexplored in COVID-19Respiratory viral infections predispose patients to co-infections and these lead to increased disease severity and mortality.Most fatalities in the 1918 influenza outbreak were due to subsequent bacterial infection, particularly with Streptococcus pneumoniae. 1 Poor outcomes in the 2009 H1N1 influenza pandemic were also associated with bacterial co-infections, although few studies captured these data. 2 Despite the proven importance of co-infections in the severity of respiratory diseases, they are understudied during large outbreaks of respiratory infections.Zhou and colleagues 3 showed that in the current coronavirus disease 2019 (COVID-19) pandemic, 50% of patients with COVID-19 who have died had secondary bacterial infections, and Chen and colleagues 4 have recorded both bacterial and fungal co-infections.Although 71% of the admitted patients with COVID-19 received antibiotic drugs, no information is available on the antimicrobial sensitivities of the organisms that were identified, or on the type and duration of antimicrobial treatment.Chronic obstructive pulmonary disease (COPD) is a risk factor for severe COVID-19 disease and many patients with COPD will have underlying chronic bacterial infections before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but this important