Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Carlota Gudiol ,F Gabilán,M Martínez-Cutillas,Marina Machado ,Claudia González-Rico ,Clara Maluquer ,Manuela Aguilar‐Guisado ,Pilar Martín-Dávila ,Hugo Manuel Paz Morales ,Luisa Sorlí ,Fabián Herrera ,Tessa M Andermann ,Cristina Royo-Cebrecos ,Ghady Haidar ,Xavier Durà-Miralles ,Bircan Kayaaslan ,Juan Aguilar-Company ,Mar Marín ,Natàlia Pallarès ,Pilar Hernández-Jiménez ,Claudia Salgueira ,Françesc Fernández-Avilés ,André Silva‐Pinto ,Çağlayan Merve Ayaz ,Edson Abdala ,Lourdes Vázquez ,Maddalena Peghin ,Ignacio Márquez-Gómez ,Josune Goikoetxea ,Belén Gutiérrez‐Gutiérrez ,Nathalie De Castro ,Sandra Cuéllar ,Jordi Carratalà

doi:10.1016/j.jinf.2021.07.014

Abstract

BackgroundWe aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. MethodsInternational, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. ConclusionsInfectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized.

Highlights

Bacterial and fungal infections represent a significant complication in some viral diseases, such as influenza. 1 Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, several studies have been published describing the epidemiology of infectious complications of COVID-19
In our large multinational cohort of onco-hematological patients with COVID-19, we found that the rate of co-infections at the time of diagnosis was more than double the rate reported in the general population[2,3,4,5] but the rate of superinfections was comparable to those observed in previous reports in the general population.[6,7,8,9]
Our data highlight the need for improved diagnostics to identify patients at highest risk for infections following COVID-19, in order to prioritize these patients for antimicrobial therapy

Summary

Introduction

Bacterial and fungal infections represent a significant complication in some viral diseases, such as influenza. 1 Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, several studies have been published describing the epidemiology of infectious complications of COVID-19. Nosocomial superinfections appear to be more frequent than co-infections, among patients admitted to the intensive care unit (ICU) and those receiving high doses of corticosteroids[4,6,7,8,9]. These patients develop high rates of bloodstream infections and ventilator-associated pneumonia. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized

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