INTRODUCTION The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. PATIENTS AND METHODS We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763. RESULTS Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of superinfection was 24% (95% CI: 19%-30%). Pooled prevalence of pathogen type stratified by co- or superinfection were: viral co-infections, 10% (95% CI: 6%-14%); viral superinfections, 4% (95% CI: 0%-10%); bacterial co-infections, 8% (95% CI: 5%-11%); bacterial superinfections, 20% (95% CI: 13%-28%); fungal co-infections, 4% (95% CI: 2%-7%); and fungal superinfections, 8% (95% CI: 4%-13%). Patients with a co-infection or superinfection had higher odds of dying than those who only had SARS-CoV-2 infection (odds ratio = 3.31, 95% CI: 1.82-5.99). Compared to those with co-infections, patients with superinfections had a higher prevalence of mechanical ventilation (45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]), but patients with co-infections had a greater average length of hospital stay than those with superinfections (mean = 29.0 days, standard deviation [SD] = 6.7 vs. mean = 16 days, SD = 6.2, respectively). CONCLUSIONS Our study showed that as many as 19% of patients with COVID-19 have co-infections and 24% have superinfections. The presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality. Our findings support the need for diagnostic testing to identify and treat co-occurring respiratory infections among patients with SARS-CoV-2 infection.

中文翻译：

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SARS-CoV-2 和其他病原体合并感染和重复感染的患病率和结果：系统评价和荟萃分析。

引言 据报道，在 SARS-CoV-2 感染患者中其他病原体的恢复，无论是在 SARS-CoV-2 感染诊断时（合并感染）还是随后（重复感染）。然而，关于合并感染和重复感染的患病率、微生物学和结果的数据有限。本研究的目的是检查 SARS-CoV-2 感染患者中合并感染和重复感染的发生情况及其结果。患者和方法 我们检索了 2019 年 10 月 1 日至 2021 年 2 月 8 日发表的研究文献数据库。我们纳入了报告住院和非住院患者中 SARS-CoV-2 和其他病原体共同感染或重复感染的临床特征和结果的研究。 - 住院患者。我们遵循 PRISMA 指南，并向 PROSPERO 注册协议：CRD42020189763。结果 在筛选的 6639 篇文章中，118 篇纳入随机效应荟萃分析。合并感染的汇总患病率为 19%（95% 置信区间 [CI]：14%-25%，I2 = 98%），重复感染的患病率为 24%（95% CI：19%-30%）。按合并感染或重复感染分层的病原体类型汇总流行率为：病毒合并感染，10%（95% CI：6%-14%）；病毒重复感染，4%（95% CI：0%-10%）；细菌合并感染，8%（95% CI：5%-11%）；细菌重复感染，20%（95% CI：13%-28%）；真菌合并感染，4%（95% CI：2%-7%）；和真菌重复感染，8%（95% CI：4%-13%）。合并感染或重复感染的患者比仅感染 SARS-CoV-2 的患者死亡几率更高（比值比 = 3.31，95% CI：1.82-5.99）。与合并感染患者相比，重复感染患者的机械通气患病率较高（45% [95% CI: 33%-58%] vs. 10% [95% CI: 5%-16%]），但合并感染患者的平均住院时间比重复感染患者的平均住院时间更长（分别为平均值 = 29.0 天，标准差 [SD] = 6.7 与平均值 = 16 天，SD = 6.2）。结论 我们的研究表明，多达 19% 的 COVID-19 患者存在合并感染，24% 存在重复感染。合并感染或重复感染的存在与不良结果相关，包括死亡率增加。我们的研究结果支持需要进行诊断测试来识别和治疗 SARS-CoV-2 感染患者中并发的呼吸道感染。