The role of co-infections and secondary infections in patients with COVID-19.
The role of co-infections and secondary infections in patients with COVID-19.
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DOI：
10.1186/s41479-021-00083-w
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发表时间：
2021-04-25
期刊：
影响因子：
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通讯作者：
Anderson R
中科院分区：
文献类型：
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作者：
Feldman C;Anderson R
人们在相当长的一段时间内就认识到，病毒性呼吸道感染会使患者容易受到细菌感染，并且这些合并感染的结果比单独感染的结果更差。然而，目前尚不清楚合并感染和/或重复感染在 COVID-19 感染患者中发挥什么确切作用。这是对当前有关 SARS-CoV-2 感染患者合并感染和重复感染的文献的广泛回顾。使用的定义是美国疾病控制和预防中心的定义，该中心将合并感染定义为与初次感染同时发生的感染，而重复感染是继先前感染后发生的感染，尤其是由对先前使用的抗生素具有耐药性或已产生耐药性的微生物引起的感染。一些研究人员设想了细菌/SARS-CoV-2 双重感染的三种潜在情况；即，细菌感染或定植后继发 SARS-CoV-2 感染、病毒/细菌合并肺炎或 SARS-CoV-2 后继发细菌重复感染。有大量已发表的文章，从给编辑的信到描述 COVID-19 患者不同范围的混合感染和/或重复感染的系统评价和荟萃分析。所描述的伴随感染包括其他呼吸道病毒、细菌（包括分枝杆菌）、真菌以及其他更不寻常的病原体。然而，正如本综述中所见，文献中通常没有明确区分作者所指的内容，无论是真正的伴随/共同感染还是双重感染。此外，还进一步讨论了病毒感染（包括 SARS-CoV-2）与其他感染（特别是细菌感染）之间相互作用的可能机制。最后，还描述了这些合并感染和重复感染对 COVID-19 感染严重程度及其结果的影响。当前的综述描述了 COVID-19 感染患者中不同的混合感染和/或重复感染率，尽管文献中常常不清楚两者之间的明确区别。当它们发生时，这些感染似乎与 COVID-19 的严重程度以及较差的结果有关。
It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. However, it is still unclear what exact roles co-infections and/or superinfections play in patients with COVID-19 infection. This was an extensive review of the current literature regarding co-infections and superinfections in patients with SARS-CoV-2 infection. The definitions used were those of the Centers for Disease Control and Prevention (US), which defines coinfection as one occurring concurrently with the initial infection, while superinfections are those infections that follow on a previous infection, especially when caused by microorganisms that are resistant, or have become resistant, to the antibiotics used earlier. Some researchers have envisioned three potential scenarios of bacterial/SARS-CoV-2 co-infection; namely, secondary SARS-CoV-2 infection following bacterial infection or colonisation, combined viral/bacterial pneumonia, or secondary bacterial superinfection following SARS-CoV-2. There are a myriad of published articles ranging from letters to the editor to systematic reviews and meta-analyses describing varying ranges of co-infection and/or superinfection in patients with COVID-19. The concomitant infections described included other respiratory viruses, bacteria, including mycobacteria, fungi, as well as other, more unusual, pathogens. However, as will be seen in this review, there is often not a clear distinction made in the literature as to what the authors are referring to, whether true concomitant/co-infections or superinfections. In addition, possible mechanisms of the interactions between viral infections, including SARS-CoV-2, and other infections, particularly bacterial infections are discussed further. Lastly, the impact of these co-infections and superinfections in the severity of COVID-19 infections and their outcome is also described. The current review describes varying rates of co-infections and/or superinfections in patients with COVID-19 infections, although often a clear distinction between the two is not clear in the literature. When they occur, these infections appear to be associated with both severity of COVID-19 as well as poorer outcomes.