Risk Factors For Co-infection Research Articles

Sex and sexual orientation as potential risk factors for co-infection with sexually transmitted infections in Surabaya, Indonesia: a single-center cross-sectional study

Objective: Sexually transmitted diseases (STDs) are infections that are transmitted from an infected person to an uninfected person through sexual contact. We conducted this study to evaluate the prevalence and the risk factors of co-infection because there hasn't been any research that thoroughly demonstrates its occurrence in Indonesia, particularly at the Dr. Soetomo General Academic Hospital in Surabaya. Methods: This research is a retrospective analytical study at Dr. Soetomo General Academic Hospital in a period of 2019-2021 primarily to assess risk factors associated with co-infection events. Patient’s data included sex, age, occupation, marital status, comorbid factors, the patient's number of sexual partners, sexual orientation, and the patient's nonsexual behavior were taken from the secondary medical records for analysis. The Chi-square test was used to analyze the correlations between variables. Results: There was a statistically significant difference in the presence of co-infections according to sex and sexual orientation (P < 0.001, P < 0.001, respectively), however, there was no statistically significant association of age, patient's occupation, marital status, commorbidity and sexual partner with co-infection in STDs. Conclusion: The incidence of co-infection is positively associated with both sex and sexual orientation in Surabaya, Indonesia.

Hepatitis B prevalence and risk factors among adults living with HIV in South Africa: a clinic-based cohort study

BackgroundPeople living with HIV (PLHIV) may have concurrent Hepatitis B Virus (HBV) infection, and certain antiretroviral therapies are recommended for HBV-HIV co-infected individuals. Routine screening for Hepatitis B virus may influence management of antiretroviral therapy for PLHIV, but risk factors for co-infection have not been well defined. The objective of this study was to identify risk factors for HBV infection among PLHIV in South Africa.MethodsWe conducted a cross-sectional analysis of a prospective, clinic-based cohort study of adults seeking HIV testing from 2013–2017 in Umlazi township, South Africa. Patients newly diagnosed with HIV were enrolled and subsequently tested for Hepatitis B surface antigen positive (HBsAg +). We used a Poisson linear regression model to assess which factors, pertaining to sociodemographic status, medical history, clinical symptoms, mental health were associated with HBV.ResultsAmong 3,105 PLHIV participants in South Africa, 6% were positive for HBV. Males had a higher HBV prevalence (10.4%) than females (5.2%). Within the HBV-positive group, the mean age was 33.2 years, with 38.3% females and 43.9% having completed high school or higher. About 39.9% reported alcohol use, 24.7% had a smoking history, and 8.3% reported substance use in the past year. Older participants born before 1995, when routine infant HBV vaccination was introduced, were more likely to have HBV. In multivariable analyses, smoking history increased HBV risk in females (aPR = 2.58; 95% CI 1.47–2.52), while alcohol use decreased HBV risk in males (aPR = 0.36; 95% CI 0.19–0.70).ConclusionsIn a South African cohort, roughly one in 16 PLHIV had HBV co-infection, and this rate was higher in males. The most prominent risk factors for HBV infection in PLHIV were alcohol use, higher income, and smoking history, which may help inform targeted treatment and prevention strategies. Creating HBV-specific screening and prevention strategies for PLHIV may be useful for reducing HBV infections.

Clinical characteristics and risk factors for bacterial co-infections in COVID-19 patients: A retrospective study

ObjectiveThis study aimed to analyse the bacterial composition, distribution, drug sensitivity, and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who develop bacterial co-infections. MethodsWe conducted a retrospective study of 184 patients with COVID-19 admitted between December 2022 and January 2023. Data on gender, age, length of hospital stay, pneumonia classification, underlying diseases, invasive surgery, hormone therapy, inflammation indicators, and other relevant information were collected. Samples of sputum, bronchoscopy sputum, alveolar lavage fluid, middle urine, puncture fluid, wound secretions, and blood were collected for pathogen isolation, identification, and drug sensitivity testing. ResultsThe majority of patients with COVID-19 with bacterial co-infection were elderly and had underlying diseases. Invasive surgery and hormone therapy were identified as risk factors for co-infections. Laboratory analysis showed reduced lymphocyte counts and elevated levels of C-reactive protein and procalcitonin. The most common pathogens in co-infections were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. The detection rate of drug-resistant strains, including methicillin-resistant S. aureus, carbapenem-resistant K. pneumoniae, carbapenem-resistant A. baumannii, carbapenem-resistant P. aeruginosa, and carbapenem-resistant E. coli, increased with the severity of pneumonia. ConclusionRespiratory tract infections were the most common site of bacterial co-infection in patients with COVID-19. Severe cases were more susceptible to multidrug-resistant pathogens, leading to a higher mortality rate. Timely control and prevention of co-infection are crucial for improving the prognosis of patients with COVID-19.

Risk factors, outcomes, and epidemiological and etiological study of hospitalized COVID-19 patients with bacterial co-infection and secondary infections

BackgroundAs a common complication of viral respiratory tract infection, bacterial infection was associated with higher mortality and morbidity. Determining the prevalence, culprit pathogens, outcomes, and risk factors of co-infection and secondary infection occurring in hospitalized patients with coronavirus disease 2019 (COVID-19) will be beneficial for better antibiotic management.MethodsIn this retrospective cohort research, we assessed clinical characteristics, laboratory parameters, microbiologic results, and outcomes of laboratory-confirmed COVID-19 patients with bacterial co-infection and secondary infection in West China Hospital from 2022 December 2nd to 2023 March 15th.ResultsThe incidence of bacterial co-infection and secondary infection, as defined by positive culture results of clinical specimens, was 16.3% (178/1091) and 10.1% (110/1091) respectively among 1091 patients. Acinetobacter, Klebsiella, and Pseudomonas were the most commonly identified bacteria in respiratory tract samples of COVID-19 patients. In-hospital mortality of COVID-19 patients with co-infection (17.4% vs 9.5%, p = 0.003) and secondary infection (28.2% vs 9.5%, p < 0.001) greatly exceeded that of COVID-19 patients without bacterial infection. Cardiovascular disease (1.847 (1.202–2.837), p = 0.005), severe COVID-19 (1.694 (1.033–2.778), p = 0.037), and critical COVID-19 (2.220 (1.196–4.121), p = 0.012) were proved to be risk factors for bacterial co-infection, while only critical COVID-19 (1.847 (1.202–2.837), p = 0.005) was closely related to secondary infection.ConclusionsBacterial co-infection and secondary infection could aggravate the disease severity and worsen clinical outcomes of COVID-19 patients. Notably, only critical COVID-19 subtype was proved to be an independent risk factor for both co-infection and secondary infection. Therefore, standard empirical antibiotics was recommended for critically ill COVID-19 rather than all the inpatients according to our research.

Screening Practices and Risk Factors for Co-Infection with Latent Tuberculosis and Hepatitis B Virus in an Integrated Healthcare System — California, 2008-2019

BackgroundHepatitis B virus (HBV) and latent tuberculosis infection are associated with a significant global burden, but both are underdiagnosed and undertreated. We described the screening patterns and risk factors for co-infection with latent tuberculosis and HBV within a large healthcare system. MethodsUsing data from Kaiser Permanente Southern California during 2008-2019, we described HBV infections, defined as a positive HBV surface antigen, e-antigen, or DNA test, and latent tuberculosis, defined as a positive Mantoux tuberculin skin test or interferon-gamma release assay test. We estimated adjusted odds ratios (aOR) for co-infection among screened adults with either infection. ResultsAmong 1997 HBV patients screened for latent tuberculosis, 23.1% were co-infected, and among 35,820 patients with latent tuberculosis screened for HBV, 1.3% were co-infected. Among HBV patients, co-infection risk was highest among Asians compared with White race/ethnicity (29.4% vs 5.7%, aOR 4.78; 95% confidence interval [CI], 2.75-8.31), and persons born in a high-incidence country compared with low-incidence countries (31.0% vs 6.6%; aOR 4.19; 95% CI, 2.61-6.73). For patients with latent tuberculosis, risk of co-infection was higher among Asian (aOR 9.99; 95% CI, 5.79-17.20), or Black race/ethnicity (aOR 3.33; 95% CI, 1.78-6.23) compared with White race/ethnicity. Persons born in high-incidence countries had elevated risk of co-infection compared with persons born in low-incidence countries (aOR 2.23; 95% CI, 1.42-3.50). However, Asians or persons born in high-incidence countries were screened at similar rates to other ethnicities or persons born in low-incidence countries. ConclusionsLatent tuberculosis risk is elevated among HBV patients, and vice versa. Risk of co-infection was highest among persons born in high-incidence countries and Asians. These findings support recent guidelines to increase HBV and tuberculosis screening, particularly among persons with either infection.

Coinfections of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review and individual participant data meta-analysis protocol

IntroductionMalaria infection and curable sexually transmitted infections and reproductive tract infections (STIs/RTIs) adversely impact pregnancy outcomes. In sub-Saharan Africa, the prevalence of malaria and curable STIs/RTIs is high and, where...

Risk Factors of Acute and Chronic Erythema Nodosum Leprosum in Dr. Soetomo General Academic Hospital Surabaya

Background: Leprosy is a chronic granulomatous infection and is one of the neglected diseases caused by Mycobacterium leprae. ENL is a complex syndrome, that caused inflammation of the skin, nerves, and other organs due to an inflammatory immune response to Mycobacterium leprae antigens. Acute ENL was defined as the first episode of ENL with a duration of less than 24 weeks. Chronic ENL was defined as ENL that persisted for more than 24 weeks. These types of ENL can have different risk factors and require different therapeutic interventions. Purpose: The onset of ENL is acute, but may progress to a chronic or recurrent phase and require long-term therapy. Early detection of leprosy is very important, because the infection is curable and prompt treatment can reduce nerve damage and associated stigma. Chronic ENL patients require prolonged high doses of corticosteroids to control inflammation in ENL and cause severe complications and side effects associated with morbidity and mortality. Methods: This retrospective study was conducted using a non-probability sampling technique consecutively using a casecontrol formula in leprosy patients with ENL in the Leprosy Division of the Outpatient Dermatology and Venereology Unit RSUD Dr. Soetomo Surabaya for the period 2015 – 2020, using secondary data in the form of medical record data. Result: The results of this study obtained leprosy patients with ENL as many as 234 patients, 56 patients with acute ENL and 89 patients with chronic ENL. 45 patients with acute ENL and 45 patients with chronic ENL were obtained from the case-control minimal sample size formula. Conclusion: The results of the bivariate analysis test showed that there was a relationship between risk factors for coinfection and steroid therapy with the type of ENL. The presence of coinfection and steroid therapy showed that patients tend to be chronic ENL, conversely, in the absence of coinfection and without steroid therapy, patients tend to be acute ENL. The multivariate logistic regression analysis test showed a significant association between risk factors for ENL onset before MDT and the presence of coinfection with chronic ENL, whereas ENL onset after MDT and absence of coinfection were associated with acute ENL.

Co-infections of major tick-borne pathogens of dogs in Andhra Pradesh, South India.

Implementing hemoprotozoan control strategies in dogs has become difficult because of the co-infections. A multiplex polymerase chain reaction (PCR) was carried out for simultaneous detection of the co-infections of Babesia gibsoni, B. vogeli, Hepatozoon canis and Ehrlichia canis from dogs (N = 442) in Andhra Pradesh, South India. The co-infection combinations were classified as (i) B. gibsoni + B. vogeli + E. canis + H. canis (BEH), (ii) B. gibsoni + B. vogeli + E. canis (BE), (iii) B. gibsoni + B. vogeli + H. canis (BH) and (iv) E. canis + H. canis (EH) groups. The parasite-specific multiplex PCR amplified 18S rRNA gene of B. gibsoni, B. vogeli and H. canis and VirB9 gene of E. canis. The age, gender, breed, medium, living condition and region of dogs were studied as risk factors for co-infections using logistic regression model. Among the co-infections, the incidence was 1.81%, 9.28%, 0.69% and 0.90% for BEH, BE, BH and EH infections, respectively. Young age (< one year), females, mongrels, rural dogs, kennel dogs and presence of ticks were the identified risk factors for overall prevalence of tick-borne pathogens. The incidence of infection was less in rainy season, especially in dogs with a previous acaricidal treatment. The study concludes that the multiplex PCR assay could simultaneously detect natural co-infections in dogs, emphasizing the need for the assay in epidemiological studies to reveal the real pattern of pathogens and select pathogen-specific treatment protocols.

Profile of Co-Infection Prevalence and Antibiotics Use among COVID-19 Patients.

Bacterial co-infection in COVID-19 patients significantly contributes to the worsening of the prognosis based on morbidity and mortality. Information on the co-infection profile in such patients could help to optimize treatment. The purpose of this study was to describe bacterial co-infections associated with microbiological, clinical, and laboratory data to reduce or avoid a secondary infection. A retrospective cohort study was conducted at Sant'Anna and San Sebastiano Hospital from January 2020 to December 2021. Bacterial co-infection was detected in 14.3% of the COVID-19-positive patients. The laboratory findings on admission showed significant alterations in the median D-dimer, C-reactive protein, interleukin-6, and lactate dehydrogenase values compared to normal values. All inflammatory markers were significantly elevated. The most common pathogens isolated from blood cultures were E. faecalis and S. aureus. Instead, the high prevalence of respiratory tract infections in the COVID-19 patients was caused by P. aeruginosa (41%). In our study, 220 (82.4%) of the COVID-19 patients received antimicrobial treatment. Aminoglycosides and β-lactams/β-lactamase inhibitors showed the highest resistance rates. Our results showed that older age, underlying conditions, and abnormal laboratory parameters can be risk factors for co-infection in COVID-19 patients. The antibiotic susceptibility profile of bacterial pathogen infection provides evidence on the importance, for the clinicians, to rationalize and individualize antibiotic usage.

1326. Possible Predictors of Coinfection in COVID-19: Making a Difficult Diagnosis

BackgroundCoinfection with COVID-19 and a secondary pathogen contributes to morbidity and mortality. Despite its contribution to outcomes, diagnosing coinfection is challenging and no predictive tools have been established. To better assess risk factors for coinfection, we performed a review of all patients hospitalized for COVID-19 in our institution and evaluated them for candidate predictors of coinfection. MethodsMedical records were reviewed in all patients admitted with COVID-19 at University of Chicago Medical Center between March 1, 2020 and April 18, 2020. Those identified as having coinfection were compared to those without coinfection. Secondary review was performed for characteristics of the coinfection, including diagnosis, microbiology, drug resistance, and nosocomial acquisition. Results401 patients were included in the study, the mean age was 60 years (SD-17), 29% had severe disease, and 13% died. At least one test for coinfection was performed in 99% of patients. Coinfection was identified in 15% (72/401) of patients. Coinfection was associated with older age, disease severity, and hospital complications, such as DVT/PE, AKI, and delirium. [Table 1] No symptom, non-microbiologic test, radiograph, or preexisting condition was associated with coinfection. Dyspnea, chest pain, and obesity were more common in those without coinfection. 74% received antibiotics. The most common sites for coinfection were urinary 33%, lower respiratory 26%, and blood 24%. [Table2] Bacteria were most frequently recovered (82%). The most commonly recovered pathogens were Enterobacterales (42%), Staphylococcus aureus (12%), and Pseudomonas (4%). 42% of the infections were hospital acquired, 16% caused by MDRO, and 13% were catheter or ventilator associated. Table 1. Clinical Characteristics Associated with Coinfection Abbreviations: sd, standard deviation; WBC, white blood cell count; CRP, C-reactive protein; COPD, chronic obstructive pulmonary disease; ARDS, acute respiratory distress syndrome; DVT, deep venous thrombosis; PE, pulmonary embolism; MI, myocardial infarction; AKI, acute kidney injuryTable 2. Characteristics of Coinfection Abbreviations: Cath, catheter; Vent, ventilator; Assoc, Associated; MDRO, Multiple Drug Resistant OrganismConclusionCoinfection in COVID-19 was most closely associated with age, COVID-19 disease severity, and complicated hospitalization. No presenting symptoms, non-microbiologic test, or radiograph was associated with coinfection, underscoring the challenge in diagnosing coinfection. A remarkable number of infections were hospital acquired, MDRO, and catheter/ventilator associated. Further prospective study on coinfection in COVID-19 is needed to guide diagnosis and treatment.Disclosures Renslow Sherer, MD, Gilead Sciences, Inc (Grant/Research Support)

277. Low Rates of Bacterial Co-infection in Hospitalized Patients with COVID-19

BackgroundThe rate of bacterial co-infection in inpatients with COVID-19 is unknown, however, patients who are hospitalized with COVID-19 often receive antibiotics for community-acquired bacterial pneumonia (CABP). Reducing unnecessary antibiotic usage in this population is important to prevent adverse effects and slow the development of antimicrobial resistance.MethodsWe performed a retrospective chart review on patients admitted to our health system between March and May 2020 with confirmed COVID-19 by nasopharyngeal PCR. We reviewed patients with positive cultures from urine, blood, sputum, and sterile sites. Positive cultures were reviewed to determine if they represented a true infection versus a contaminant or colonization. Patients with true infections were categorized as having a co-infection (CI) if the positive culture was collected within 48 hours of initial positive SARS-CoV-2 PCR test. Additional data was collected on patient demographics, types of infections, organisms grown, and antibiotic usage.Results902 patients were admitted with positive SARS-CoV-2 tests during the study period. Of these, 47 patients (5.2%) had a bacterial CI. Some patients had more than one CI, with 53 total CIs identified. The median age of patients with CI was 66 years old (39 – 90). Tables 1 and 2 describe patient characteristics and infections. A subgroup analysis on types of bacteria was done on the 20 patients with a respiratory CI, who accounted for 2.2% of all COVID-positive patients admitted during the study period. In these infections, Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae were the most common organisms, accounting for 60%, 15%, and 10% infections, respectively.Table 1. Patient Characteristics Table 2. Co-infections ConclusionThe overall rate of CIs in patients admitted with COVID-19 was low. Some of these CIs may represent an “incidentally positive” COVID-19 test if a patient presented with one infection and had asymptomatic carriage of SARS-CoV-2 when community prevalence was high. Further analysis is needed to evaluate specific risk factors for co-infection.Disclosures Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Consultant, Speaker’s Bureau)Merck (Consultant, Grant/Research Support, Speaker’s Bureau)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant) Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Individual(s) Involved: Self): Speakers' bureau; Merck (Individual(s) Involved: Self): Consultant, Grant/Research Support; Nabriva: Consultant; Qpex (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant

Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study

BackgroundEach year, 5.6 million new syphilis cases are diagnosed globally. Guidelines for people living with HIV (PLWH) in low-income countries (LIC) recommend STI testing for symptomatic persons and those newly diagnosed with HIV; routine STI testing is less clear. Here we provide updated syphilis prevalence and identify co-infection risk factors in PLWH in the African Cohort Study (AFRICOS) to understand these rates as they relate to syndromic treatment.MethodsAFRICOS is a study enrolling PLWH and HIV-uninfected individuals in four African countries. Participant study enrollment information was used to determine syphilis prevalence and co-infection risk factors. Inclusion criteria consisted of adults 18 years or older receiving care at a participating clinic as a long-term resident who consented to data and specimen collection. Exclusion criteria consisted of pregnancy and/or imprisonment. Screen-positive syphilis was defined as a reactive rapid plasma regain (RPR) upon study enrollment whereas confirmed syphilis included a reactive RPR followed by reactive treponemal test. Multivariate analyses was performed to determine HIV and syphilis co-infection risk factors.ResultsBetween 2013 and March 1, 2020, 2939 PLWH enrolled and 2818 were included for analysis. Screen-positive and confirmed syphilis prevalence were 5.3% (151/2818) and 3.1% (87/2818), respectively. When the analysis was restricted to PLWH with an RPR titer of greater than, or equal to, 1:8, 11/87 (12.6%) participants were included. No PLWH and confirmed syphilis had documented genital ulcers. In the multivariate model, participants with confirmed syphilis co-infection were more likely to have none or some primary education [aOR 3.29 (1.60, 6.74)] and consume alcohol [aOR 1.87 (1.16, 3.03)] compared to those without syphilis. Antiretroviral therapy (ART) with suppressed viral load (VL) was protective in the unadjusted model but not adjusted multivariate model.ConclusionsOur findings show that syphilis rates in sub-Saharan Africa remain elevated where diagnosis remains challenging, and that both lower education level and alcohol consumption are significantly associated with HIV/syphilis co-infection in AFRICOS. Based on our analysis, current STI guidelines targeting testing for African individuals with either new HIV diagnosis or syndromic symptoms may be inadequate, highlighting the need for increased testing and treatment strategies in resource-limited settings.

The Impacts of Aspergillosis on Outcome, Burden and Risks for Mortality in Influenza Patients with Critical Illness.

Previous studies have revealed higher mortality rates in patients with severe influenza who are coinfected with invasive pulmonary aspergillosis (IPA) than in those without IPA coinfection; nonetheless, the clinical impact of IPA on economic burden and risk factors for mortality in critically ill influenza patients remains undefined. The study was retrospectively conducted in three institutes. From 2016 through 2018, all adult patients with severe influenza admitted to an intensive care unit (ICU) were identified. All patients were classified as group 1, patients with concomitant severe influenza and IPA; group 2, severe influenza patients without IPA; and group 3, severe influenza patients without testing for IPA. Overall, there were 201 patients enrolled, including group 1 (n = 40), group 2 (n = 50), and group 3 (n = 111). Group 1 patients had a significantly higher mortality rate (20/40, 50%) than that of group 2 (6/50, 12%) and group 3 (18/11, 16.2%), p < 0.001. The risk factors for IPA occurrence were solid cancer and prolonged corticosteroid use in ICU of >5 days. Group 1 patients had significantly longer hospital stay and higher medical expenditure than the other two groups. The risk factors for mortality in group 1 patients included patients’ Charlson comorbidity index, presenting APACHE II score, and complication of severe acute respiratory distress syndrome. Overall, IPA has a significant adverse impact on the outcome and economic burden of severe influenza patients, who should be promptly managed based on risk host factors for IPA occurrence and mortality risk factors for coinfection with both diseases.

Concomitant infections in patients with cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) study.

6561 Background: COVID-19 has been associated with immune modulation that may predispose infected patients to bacterial, viral, or fungal co-infections. Due to critical illness, &gt; 70% of patients with severe COVID-19 receive empiric antibacterial or antifungal therapy, along with standard anti-COVID-19 treatments. However, the frequency of proven or probable secondary infections is &lt; 10%. To our knowledge, there are no studies evaluating co-infections in patients with cancer and COVID-19, a vulnerable group with multiple risk factors for co-infections. We aim to describe the prevalence of bacterial, viral, and fungal co-infections, identify risk factors for coinfection, and investigate the potential impact of co-infections on mortality, in patients with a history of cancer and COVID-19. Methods: The CCC19 registry (NCT04354701) includes patients with active or prior hematologic or invasive solid malignancies reported across academic and community sites. We captured bacterial, fungal, or viral co-infections diagnosed within ±2 weeks from diagnosis of COVID-19, identified factors associated with an increased risk of having a co-infection, and evaluated the association of co-infections with 30-day all-cause mortality. Results: We examined 6732 patients with a history of cancer and a laboratory-confirmed diagnosis of SARS-CoV-2 reported to CCC19 by 82 sites between March 17, 2020 and February 3, 2021, with complete data on coinfection status. Median age was 65 (interquartile range: 55-75) years with 48% male, 52% non-Hispanic white, 19% non-Hispanic black, and 16% Hispanic. 5448 (81%) had solid tumors and 1466 (22%) had hematologic malignancies. Bacterial infections were reported in 823 patients (12%), including 296 Gram+ and 245 Gram- bacterial events. Documented viral (176 patients, 3%) and fungal (59 patients, 0.9%) co-infections were rare. The risk for co-infections increased with age, and they were more frequent among men, older patients, and those with diabetes, pulmonary or renal comorbid conditions, active progressive cancer, or hematologic malignancies (unadjusted P&lt; 0.01). The frequency of reported co-infections decreased over the study period (divided into quartiles, Mantel-Haenszel P&lt; 0.01). All-cause mortality rates were higher among those with bacterial (24% vs. 10%), viral (22% vs. 12%), and fungal (37% vs. 12%) coinfections compared to those without (unadjusted P&lt; 0.01). Conclusions: The frequency of bacterial infections in patients with cancer and COVID-19 is relatively low. Viral and fungal co-infections are uncommon. Co-infections are associated with higher mortality rates. Several patient and tumor factors can be used for risk stratification and guide early empiric antimicrobial agent selection, which may improve clinical outcomes. These data could inform antimicrobial stewardship interventions in this tenuous patient population.

Risk Factors for the Co-infection with HIV, Hepatitis B and C Virus in Syphilis Patients.

Syphilis, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) share transmission routes. Syphilis infection can increase the risk of acquiring and transmitting HIV in key populations. The aims of this study were to investigate the risk factors and co-infection patterns for HIV, HBV and HCV in patients with syphilis. A retrospective study was conducted of 2,412 patients with syphilis (1,922 (79.68%) with latent syphilis, 336 (13.93%) with secondary syphilis, 78 (3.23%) with primary syphilis, 72 (2.99%) with tertiary syphilis, and 4 (0.17%) with congenital syphilis). Positive results were observed in 8.21% (134/1,620) of patients tested for HIV, 5.75% (82/1,427) for HBV, and 1.02% (14/1,374) for HCV, respectively. Multivariate logistic regression analysis found that male sex (adjusted odds ratio (AOR) 26.03; 95% confidence interval (CI) 10.37–65.36), age < 55 years, especially age group 25–34-years (AOR 8.06; 95% CI 4.16–15.61), diagnosed at the Department of Infectious Disease (AOR 19.16; 95% CI 9.74–37.69), patients from Southern China, which is a geographical area south of the Qinling-Huaihe line (AOR 1.86; 95% CI 1.06–3.26) and having a rapid plasma reagin titre ≥ 1:32 (AOR 1.88; 95% CI 1.12–3.15) were independently associated with HIV infection. Risk factors for HBV co-infection in patients with syphilis, including male sex (AOR 1.78; 95% CI 1.12–2.83) and living in Southern China (AOR 4.66; 95% CI, 2.36–9.17) were also identified.

Bacterial co-infections and antibiotic prescribing practice in adults with COVID-19: experience from a single hospital cluster.

Background: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected millions of individuals since December 2019, resulting in significant morbidity and mortality globally. During the 1918 Influenza Pandemic, it was observed that influenza was associated with bacterial co-infections. However, empirical or prophylactic antibiotic use during viral pandemics should be balanced against the associated adverse drug events. Methods: In this retrospective cohort study, we investigated bacterial co-infections in adults with COVID-19 in Hong Kong. Notably, at the time of writing this report, patients with varying disease severities were isolated in hospitals until confirmatory evidence of virological clearance or immunity was available. The study included adults with laboratory-confirmed COVID-19 admitted to a single hospital cluster between 8 January 2020 and 1 May 2020. We obtained data regarding patient demographics, clinical presentations, blood test results, treatment, and outcomes. Bacteriological profiles and risk factors for co-infections were investigated. Antibiotic prescription practices were also reviewed. Results: Of the 147 patients recruited, clinical disease was suspected in 42% (n = 62) of patients who underwent testing for other respiratory infections. Notably, 35% (n = 52) of the patients were prescribed empirical antibiotics, predominantly penicillins or cephalosporins. Of these, 35% (n = 18) received more than one class of antibiotics and 37% (n = 19) received empirical antibiotics for over 1 week. Overall, 8.2% (n = 12) of patients developed bacterial co-infections since the detection of COVID-19 until discharge. Methicillin-susceptible Staphylococcus aureus was the most common causative pathogen identified. Although 8.2% (n = 12) of patients developed hypoxia and required oxygen therapy, no mortality was observed. Multivariate analysis showed that pneumonic changes on chest radiography at the time of admission predicted bacterial co-infections. Conclusion: These findings emphasise the importance of judicious administration of antibiotics throughout the disease course of COVID-19 and highlight the role of antimicrobial stewardship during a pandemic.

Cytomegalovirus co-infection with HIV in children and adolescents on antiretroviral therapy in Abuja, Nigeria

Background: Cytomegalovirus (CMV) co-infection with human immunodeficiency virus (HIV) is known to accelerate HIV disease progression. It has the potential of being a killer disease or a silent lifetime companion in HIV patients. There is dearth of information on CMV prevalence among HIV infected children and adolescents in our environment. We therefore conducted this study to determine its sero-prevalence, and risk factors for co-infection among HIV infected children and adolescents on highly active antiretroviral therapy (HAART) in our center. Method: A descriptive cross sectional study of HIV-infected children and adolescents aged 2 months to 18 years on HAART was conducted over a 6 month period between October 2017 and March 2018 in our health facility. Blood samples of subjects were screened for CMV IgM using commercial test kits. Biodata of subjects, CD4 cell count, and viral load were collected into a designed proforma, and statistical analysis was done with SPSS version 22.0.Result: A total of 161 HIV-infected children and adolescents were recruited, 103 (64.0%) were males, 83 (51.6%) were between the ages of 5 and 0.05). Multivariate analysis however did not show any significant difference in age, weight, length/height, and systolic blood pressure. Conclusion: The prevalence of active CMV infections among HIV infected children and adolescents on HAART in our centre is high. Low CD4 cell count and high viral load were not associated with active CMV disease, and no risk factor for co-infection was also identified. Identifying those with primary/active infection will be necessary for possible treatment with anti-herpes drugs before development of reactivated CMV disease. Keywords: CMV; HIV; co-infection; anti-retroviral; children; adolescents

Sexually transmitted infections, the silent partner in HIV-infected women in Zimbabwe.

BackgroundCoinfection rates of HIV and sexually transmitted infections (STIs) are not widely reported in Zimbabwe and no local guidelines regarding the screening of STIs in people living with HIV exist.ObjectivesThis cross-sectional study was conducted to determine the prevalence and associated risk factors for STI coinfection in a cohort of HIV-infected women.MethodsBetween January and June 2016, 385 HIV-infected women presenting for routine cervical cancer screening were tested for five STIs: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Herpes Simplex Virus (HSV) type 2 and Treponema pallidum (TP). Socio-demographic characteristics and sexual history were recorded. Multiple logistic regression was used to identify factors associated with the diagnosis of non-viral STIs.ResultsTwo hundred and thirty-three participants (60.5%) had a confirmed positive result for at least one STI: HSV 2 prevalence 52.5%, TV 8.1%, CT 2.1%, NG 1.8% and TP 11.4%. Eighty-seven per cent of the women were asymptomatic for any STI; 62.3% of women with a non-viral STI were asymptomatic. Women who had attended tertiary education were 90% less likely to have a non-viral STI (adjusted odds ratio [aOR]: 0.10, 95% confidence interval [CI]: 0.03–0.39, p < 0.01). Having more than three lifetime sexual partners was a significant predictor for a non-viral STI diagnosis (aOR: 3.3, 95% CI: 1.5–7.2, p < 0.01).ConclusionA high prevalence of predominantly asymptomatic STIs is reported in a cohort of HIV-infected women. Syndromic management results in underdiagnosis of asymptomatic patients. More than three lifetime sexual partners and less formal education are risk factors for coinfection with non-viral STI. High-risk women should be screened using aetiological methods.

Prevalence and Genotypes of HBV and HCV and the risk Factors for co-infection with HIV-1 Among Patients attending Ngong Sub-County Hospital, Kenya

Prevalence and Genotypes of HBV and HCV and the risk Factors for co-infection with HIV-1 Among Patients attending Ngong Sub-County Hospital, Kenya

Human papillomavirus infection among women attending family planning clinic in Nigeria: prevalence, correlates, and co-infection with Chlamydia trachomatis

ABSTRACTInfection with high-risk genotypes of human papillomavirus (HPV) is considered the main cause of invasive cervical. A number of epidemiologic studies have suggested that HPV and Chlamydia trachomatis (CT) play a synergistic role in the etiology of cervical intraepithelial neoplasia and subsequent cervical cancer. The current study aimed to evaluate the HPV prevalence and the risk factors for co-infection with CT among women attending family planning clinic in Nigeria. Following enrolment, 90 patients were screened for IgG antibodies to virus-like proteins of HPV types 6, 8, 16, and 18. CT seropositivity was tested by enzyme-linked immunosorbent assay for the detection of IgG and IgM antibodies. The prevalence of HPV IgG was 20%. Seropositivity for CT IgM was 77.8% while the IgG was 0%. A total of 10 women (11.1%) were seropositive for both CT IgM and HPV IgG antibodies. Seropositivity for HPV IgG was significantly associated with age at marriage (P < 0.001), current Chlamydia infection (P < 0.011), and number of children (P < 0.025), while seropositivty for HPV IgG and Chlamydia trahomatis IgM was significantly associated with age at coitarche (P < 0.028), number of life sex partners (P < 0.033), and history of multiple sexual partners (P < 0.002).