Global coinfections with bacteria, fungi, and respiratory viruses in children with SARS-CoV-2: A systematic review and meta-analysis

Background: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. Objectives: To identify th...

Full description

Saved in:

Bibliographic Details
Published in:	Tropical medicine and infectious disease Vol. 7; no. 11; pp. 1 - 37
Main Authors:	Alhumaid, Saad, Alabdulqader, Muneera, Al Dossary, Nourah, Al Alawi, Zainab, Alnaim, Abdulrahman A, Al Mutared, Koblan M, Al Noaim, Khalid, Al Ghamdi, Mohammed A, Albahrani, Suha Jafar, Alahmari, Abdulaziz A, Al Hajji Mohammed, Sarah Mahmoud, Almatawah, Yameen Ali, Bayameen, Omar Musa, Alismaeel, Ahmed Abdulwhab, Alzamil, Sherifah Khaled, Alturki, Samiah Ahmad, Albrahim, Zahra'a Radi, Al Bagshi, Nasreen Ahmad, Alshawareb, Hesham Yousef, Alhudar, Jaafar Abdullah, Algurairy, Qassim Abdulatif, Alghadeer, Samirah Mansour, Alhadab, Hassan Ali, Aljubran, Taleb Nasser, Alabdulaly, Yousif Ahmad, Al Mutair, Abbas, Rabaan, Ali A
Format:	Journal Article
Language:	English
Published:	Basel, Switzerland MDPI 15-11-2022 MDPI AG
Subjects:	Asymptomatic Bacteria bacterial Bias Care Case reports children Clinical outcomes co-infection Cohort analysis coinfection concurrent Coronaviruses COVID-19 Disease transmission Diseases Fungi Immunological aspects Infections Intensive care Laboratories Meta-analysis Pathogens Patients Pediatrics Polymerase chain reaction Prevention Respiratory distress syndrome Respiratory infections Risk factors SARS (Disease) Severe acute respiratory syndrome coronavirus 2 Systematic Review Ventilators Viral infections Viruses COVID-19 fungal SARS-CoV-2 bacterial co-infection children concurrent meta-analysis viral systematic review coinfection pediatric
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. Objectives: To identify the type and proportion of coinfections with SARS-CoV-2 and bacteria, fungi, and/or respiratory viruses, and investigate the severity of COVID-19 in children. Methods: For this systematic review and meta-analysis, we searched ProQuest, Medline, Embase, PubMed, CINAHL,Wiley online library, Scopus, and Nature through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies on the incidence of COVID-19 in children with bacterial, fungal, and/or respiratory coinfections, published from 1 December 2019 to 1 October 2022, with English language restriction. Results: Of the 169 papers that were identified, 130 articles were included in the systematic review (57 cohort, 52 case report, and 21 case series studies) and 34 articles (23 cohort, eight case series, and three case report studies) were included in the meta-analysis. Of the 17,588 COVID-19 children who were tested for co-pathogens, bacterial, fungal, and/or respiratory viral coinfections were reported ('n' = 1633, 9.3%). The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: 'n' = 204, 59.1% compared to female gender: 'n' = 141, 40.9%). The majority of the cases belonged to White (Caucasian) ('n' = 441, 53.3%), Asian (n = 205, 24.8%), Indian (n = 71, 8.6%), and Black (n = 51, 6.2%) ethnicities. The overall pooled proportions of children with laboratory-confirmed COVID-19 who had bacterial, fungal, and respiratory viral coinfections were 4.73% (95% CI 3.86 to 5.60, 'n' = 445, 34 studies, 'I2' 85%, 'p' < 0.01), 0.98% (95% CI 0.13 to 1.83, 'n' = 17, six studies, 'I2' 49%, 'p' < 0.08), and 5.41% (95% CI 4.48 to 6.34, 'n' = 441, 32 studies, I2 87%, 'p' < 0.01), respectively. Children with COVID-19 in the ICU had higher coinfections compared to ICU and non-ICU patients, as follows: respiratory viral (6.61%, 95% CI 5.06-8.17, 'I2' = 0% versus 5.31%, 95% CI 4.31-6.30, 'I2' = 88%) and fungal (1.72%, 95% CI 0.45-2.99, 'I2' = 0% versus 0.62%, 95% CI 0.00-1.55, 'I2' = 54%); however, COVID-19 children admitted to the ICU had a lower bacterial coinfection compared to the COVID-19 children in the ICU and non-ICU group (3.02%, 95% CI 1.70-4.34, 'I2' = 0% versus 4.91%, 95% CI 3.97-5.84, 'I2' = 87%). The most common identified virus and bacterium in children with COVID-19 were RSV ('n' = 342, 31.4%) and 'Mycoplasma pneumonia' ('n' = 120, 23.1%). Conclusion: Children with COVID-19 seem to have distinctly lower rates of bacterial, fungal, and/or respiratory viral coinfections than adults. RSV and 'Mycoplasma pneumonia' were the most common identified virus and bacterium in children infected with SARS-CoV-2. Knowledge of bacterial, fungal, and/or respiratory viral confections has potential diagnostic and treatment implications in COVID-19 children.
Bibliography:	Informit, Melbourne (Vic) Tropical Medicine and Infectious Disease, Vol. 7, No. 11, Nov 2022, 1-37 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	2414-6366 2414-6366
DOI:	10.3390/tropicalmed7110380