Frequency and etiology of bacterial and fungal coinfections in patients with COVID-19 admitted to an intensive care unit in Oruro, Bolivia, 2021–2022.
Main Article Content
Keywords
COVID-19, Coinfection, Bacterial Infections, Fungal Infections, Intensive Care Units
Abstract
Objective: To determine the frequency and etiologic agents of bacterial and fungal coinfections in patients with COVID-19 hospitalized in the intensive care unit (ICU) of Hospital Obrero No. 4 in Oruro, Bolivia. Methods: A quantitative, observational, descriptive, cross-sectional study was conducted in 146 adult patients with RT-PCR–confirmed COVID-19 admitted to the ICU between January 2021 and December 2022. Demographic characteristics and microbiological isolates obtained from clinical specimens were described. Analyses included descriptive statistics and Pearson’s chi-square test, with statistical significance set at p<0.05. Results: Bacterial coinfections were identified in 65.1% of patients and fungal coinfections in 34.9%. The most frequent bacterial agents were Escherichia coli (15.8%), Staphylococcus aureus (13.7%), Staphylococcus epidermidis (6.8%), and Klebsiella pneumoniae (6.2%). Among fungal coinfections, Candida spp. predominated (26.7%), followed by Candida albicans (8.2%). Coinfections were more frequent in males and in the 62–71-year age group; however, no statistically significant associations were observed with sex (p=0.976) or age group (p=0.697). Conclusion: Bacterial and fungal coinfections were frequent among patients with COVID-19 admitted to the ICU. These findings support continuous microbiological surveillance and strengthening infection prevention and control measures to optimize clinical management and reduce associated morbidity and mortality.
References
2. Bengoechea JA, Bamford CG. SARS-CoV-2, bacterial co-infections, and AMR: the deadly trio in COVID-19? EMBO Mol Med. 2020;12(7):e12560. doi:10.15252/emmm.202012560
3. Lamers MM, Beumer J, van der Vaart J, Knoops K, Puschhof J, Breugem TI, et al. SARS-CoV-2 productively infects human gut enterocytes. Science. 2020;369(6499):50-4. doi:10.1126/science.abc1669
4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext
5. Naseef HA, Mohammad U, Al-Shami N, Sahoury Y, Abukhalil AD, Dreidi M, et al. Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study [Internet]. F1000Research. 2022 [citado 19 dic 2024]. Disponible en: https://f1000research.com/articles/11-30
6. Molano MF, R MJ, Xavier N, Mario G, Cesar E, Mario V, et al. The duration of mechanical ventilation is the main cause of bacterial/fungal superinfection in critically ill patients with COVID-19 at altitude. J Exp Pathol. 2022;3(2):55-64. doi:10.33696/pathology.3.040
7. Santos Magne PA. Epidemiologia de la bacteriemia por Klebsiella aerogenes en pacientes con COVID-19. Rev Med Paz. 2024;30(3):9-17. Disponible en: http://www.scielo.org.bo/pdf/rmcmlp/v30n3/1726-8958-rmcmlp-30-03-9.pdf
8. Nair AV, Ramanathan S, Sanghavi P, Manchikanti V, Satheesh S, Al-Heidous M, et al. Espectro de coinfecciones pulmonares fúngicas oportunistas en COVID-19: lo que el radiólogo debe saber. Radiologia. 2022;64(6):533-41. Disponible en: https://www.sciencedirect.com/science/article/pii/S0033833822001655
9. Rutsaert L, Steinfort N, Van Hunsel T, Bomans P, Naesens R, Mertes H, et al. COVID-19-associated invasive pulmonary aspergillosis. Ann Intensive Care. 2020;10:71. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265874/
10. Macauley P, Epelbaum O. Epidemiology and mycology of candidaemia in non-oncological medical intensive care unit patients in a tertiary center in the United States: overall analysis and comparison between non-COVID-19 and COVID-19 cases. Mycoses. 2021;64(6):634-40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013328/
11. Thyagarajan RV, Mondy KE, Rose DT. Cryptococcus neoformans bloodstream infection in severe COVID-19 pneumonia. IDCases. 2021;26:e01274. doi:10.1016/j.idcr.2021.e01274
12. Ali GA, Husain A, Salah H, Goravey W. Trichosporon asahii fungemia and COVID-19 co-infection: an emerging fungal pathogen; case report and review of the literature. IDCases. 2021;25:e01244. doi:10.1016/j.idcr.2021.e01244
13. Bartoletti M, Pascale R, Cricca M, Rinaldi M, Maccaro A, Bussini L, et al. Epidemiology of invasive pulmonary aspergillosis among intubated patients with COVID-19: a prospective study. Clin Infect Dis. 2021;73(11):e3606-14. doi:10.1093/cid/ciaa1065
14. Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect. 2020;26(10):1395-9. Disponible en: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30369-4/fulltext
15. Quiñones-Laveriano DM, Soto A, Quilca-Barrera L. Frecuencia de coinfección por patógenos respiratorios y su impacto en el pronóstico de pacientes con COVID-19. Rev Fac Med Hum. 2021;21(3):610-22. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_abstract&pid=S2308-05312021000300610&lng=es&nrm=iso&tlng=es
16. Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, et al. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020;104(18):7777-85. doi:10.1007/s00253-020-10814-6
17. Calzadilla YA, Morales YD, Díaz LAO, Martínez OLG, Enríquez OAL, Álvarez M de LS. Infecciones bacterianas asociadas a la COVID-19 en pacientes de una unidad de cuidados intensivos [Internet]. Rev Cub Med Mil. 2020 [citado 24 sep 2023];49(3). Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=101987&id2=
18. Bravo F, Galván G, Arancibia JM. Infecciones bacterianas en pacientes internados por COVID-19 en unidad de paciente crítico. Rev Chil Infectol. 2022;39(2):224-6. doi:10.4067/S0716-10182022000200224
19. Karaca B, Aksun M, Karahan NA, Girgin S, Örmen B, Tuzen AS, et al. Are bacterial coinfections really rare in COVID-19 intensive care units? Eur J Med Res [Internet]. 2023 [citado 23 dic 2024];28(1). Disponible en: https://doi.org/10.1186/s40001-023-01004-x
20. Ripa M, Galli L, Poli A, Oltolini C, Spagnuolo V, Mastrángelo A, et al. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors. Clin Microbiol Infect [Internet]. 2021 [citado 23 dic 2024];27(3). Disponible en: https://doi.org/10.1016/j.cmi.2020.10.021
21. Liu J, Liu W, Fan P, Huang R, Wen Y, Gao Y, et al. Respiratory tract pathogen profiles of COVID-19 pneumonia patients and the mortality prediction [Internet]. 2024 [citado 23 dic 2024]. doi:10.21203/rs.3.rs-4632591/v1
22. Obeidat H, Elnasser Z, Amarin Z, Qablan A, Gharaibeh F. The impact of COVID-19 pandemic on healthcare associated infections: a teaching hospital experience. Medicine (Baltimore) [Internet]. 2023 [citado 23 dic 2024];102(15). Disponible en: https://doi.org/10.1097/MD.0000000000033488
23. Molina AP, Muñoz V, Olocco C, Vacaflor L, Peralta N, Gerván N. Coinfección y sobreinfección bacteriana en pacientes con neumonía por COVID-19 en el Nuevo Hospital San Roque de Córdoba (2020). Rev Bioquim Patol Clin. 2022;86(3):45-56. doi:10.62073/bypc.v86i3.229
24. Martins AC, Psaltikidis EM, de Lima TC, Fagnani R, Schreiber AZ, Conterno L de O, et al. COVID-19 and invasive fungal coinfections: a case series at a Brazilian referral hospital. J Med Mycol. 2021;31(4):101175. doi:10.1016/j.mycmed.2021.101175
25. Messina FA, Marin E, Valerga M, Depardo R, Chediak V, Romero M de las M, et al. Infecciones fúngicas en pacientes con COVID-19 [Internet]. Actual En Sida E Infectol. 2021 [citado 20 mar 2023]. Disponible en: https://revista.infectologia.info/index.php/revista/article/view/49
26. Pruthi HS. When to initiate antifungal treatment in COVID-19 patients with secondary fungal co-infection. Curr Clin Microbiol Rep [Internet]. 2022 [citado 23 dic 2024];9(4). Disponible en: https://doi.org/10.1007/s40588-022-00184-0
27. Rothe K, Feihl S, Schneider J, Wallnöfer F, Wurst M, Lukas M, et al. Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship. Eur J Clin Microbiol Infect Dis. 2021;40(4):859-69. doi:10.1007/s10096-020-04063-8
Article Sidebar
Article Details
Copyright (c) 2026 MSc Moria Villca Chuquichambi, MD Alex Coca-Ardaya
This work is licensed under a Creative Commons Attribution 4.0 International License.
RHCS uses the Creative Commons License 4.0 International (CC BY 4.0). For more information, please visit
MSc Moria Villca Chuquichambi, Universidad Privada Domingo Savio. Cochabamba, Bolivia.
Magister Scientiarum (MSc.) en Microbiología clínica