Random Effects Meta-Analysis of COVID-19/S. Aureus Partnership in Co-Infection

Abstract

Aim: COVID-19 /S. aureus coinfection exacerbates morbidity and mortality among patients with coronavirus infection. This study aims to report the pooled burden of S. aureus co-infections in patients hospitalized with COVID-19. Methods: We searched electronic databases and bibliography of pertinent papers for articles. We considered studies that the core result was the number of patients with bacterial (S. aureus) co-infection. We performed random effects meta-analysis (REM) because the studies included were sampled from a universe of different populations and high heterogeneity was anticipated. Using the Cochran’s Q statistic, the observed dispersion (heterogeneity) among effect sizes was assessed. The percentage of total variability in the estimates of the effect size was calculated with the I2 index. To check for publication bias; Egger weighted regression, Begg rank correlation and meta-funnel plot was used. We conducted meta-regression analysis to evaluate the variability between our outcomes and the covariates using computational options like “methods of moments” and then “maximum likelihood” ratio. Results: We included Eighteen studies and retrieved data for 63,370 patients hospitalized with influenza-like-illness, about 14,369 (22.67%) tested positive for COVID-19 by rRT-PCR. Of this number, 8,249 (57.4%) patient samples were analyzed. Bacterial, fungal and viral agents were detected in 3,038 (36.8%); S. aureus in 1,192 (39.2%). Five studies reported MRSA co-infection. Study quality ranged from 6 to 9 (median 7.1) on a JBI scale. From the meta-analysis, 33.1% patients were coinfected (95%, CI 18.0 to 52.6%, Q=3473: df =17, I2 =99·48%, p = 0.00). The rate of S. aureus /covid-19 co-infection was 25.6% (95% CI: 15.6 to 39.0, Q=783.4, df=17, I²=97.702%, p = 0.003).The proportion of COVID-19/S. aureus co-infected patients with MRSA was 53.9% (95% CI, 24.5 to 80.9, n=66, 5 studies, Q=29.32, df=4, I²=86.369%, p=0.000). With multivariate meta-regression model, study type (p=0.029), quality (p=0.000) and country (p=0.000) were significantly associated with heterogeneity.Conclusions: The pooled rates of S. aureus among COVID-19 patients documented in this study supports the apprehensiveness of clinicians concerning the extent of the bacteria in co-infections. Improved antibiotic stewardship can be accomplished through rapid diagnosis by longitudinal sampling of patients.