Abstract
Fungal or bacterial co-infections in patients with H1N1 influenza have already been reported in many studies. However, information on the risk factors, complications, and prognosis of mortality cases with coronavirus disease 2019 (COVID-19) are limited. We aimed to assess 36 mortality cases of 178 hospitalized patients among 339 patients confirmed to have had SARS-CoV-2 infections in a medical center in the Wenshan District of Taipei, Taiwan, between January 2020 and September 2021. Of these 36 mortality cases, 20 (60%) were men, 28 (77.7%) were aged >65 years, and the median age was 76 (54–99) years. Comorbidities such as hypertension, coronary artery disease, and chronic kidney disease were more likely to be found in the group with length of stay (LOS) > 7 d. In addition, the laboratory data indicating elevated creatinine-phosphate-kinase (CPK) (p < 0.001) and lactic acid dehydrogenase (LDH) (p = 0.05), and low albumin (p < 0.01) levels were significantly related to poor prognosis and mortality. The respiratory pathogens of early co-infections (LOS < 7 d) in the rapid progression to death group (n = 7 patients) were two bacteria (22.2%) and seven Candida species (77.8.7%). In contrast, pathogens of late co-infections (LOS > 7 d) (n = 27 patients) were 20 bacterial (54.1%), 16 Candida (43.2%), and only 1 Aspergillus (2.7%) species. In conclusion, the risk factors related to COVID-19 mortality in the Wenshan District of Taipei, Taiwan, were old age, comorbidities, and abnormal biomarkers such as low albumin level and elevated CPK and LDH levels. Bacterial co-infections are more common with Gram-negative pathogens. However, fungal co-infections are relatively more common with Candida spp. than Aspergillus in mortality cases of COVID-19.
Highlights
We collected and analyzed data on 36 mortality cases of SARS-CoV-2 infections between January 2020 and September 2021 from a medical center in the Wenshan District of Taipei, Taiwan, which were confirmed by reverse-transcription polymerase chain reaction (RT-PCR) (Figure 1)
There were 339 patients with COVID-19 infections noted during the study period, and 178 patients were admitted to the ward for management and treatment (Figure 2)
While bacterial and viral co-infections at the time of SARS-CoV-2 diagnosis seem to be rare in early hospitalization [1,2,3], co-infections commonly arise in the late period of hospitalization in patients with COVID-19 [1,2,3,4], with their frequency increasing with the severity of the disease
Summary
The novel coronavirus disease was first reported in Wuhan, China, in December. 2019 ( the name, COVID-19) and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has severely impacted the healthcare system globally. More than 15,000 confirmed cases and 898 deaths have been reported in Taiwan. Information concerning the clinical impact of co-infections with fungi or bacteria in COVID-19 mortality patients is still limited, and results vary in different areas of the world
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