Respiratory co-infections in COVID-19-positive patients

Background Opportunistic respiratory infections may complicate critically ill patients with COVID-19. Early detection of co-infections helps to administrate the appropriate antimicrobial agent, to guard against patient deterioration. This study aimed at estimating co-infections in COVID-19-positive patients. Methods Eighty-nine COVID-19-positive patients confirmed by SARS-COV-2 PCR were tested for post-COVID-19 lower respiratory tract co-infections through bacterial culture, fungal culture and galactomannan (GM) testing. Results Fourteen patients showed positive coinfection with Klebsiella , nine with Acinetobacter , six with Pseudomonas and three with E. coli . As for fungal infections, nine showed coinfection with Aspergillus , two with Zygomycetes and four with Candida . Galactomannan was positive among one patient with Aspergillus coinfection, one with Zygomycetes coinfection and three with Candida , 13 samples with negative fungal culture were positive for GM. Ten samples showed positive fungal growth, however, GM test was negative. Conclusion In our study, SARS-COV-2 respiratory coinfections were mainly implicated by bacterial pathogens; most commonly Klebsiella species (spp.), Aspergillus spp. were the most common cause of fungal coinfections, GM test showed low positive predictive value for fungal infection. Respiratory coinfections may complicate SARS-COV-2 probably due to the prolonged intensive care units (ICU) hospitalization, extensive empiric antimicrobial therapy, steroid therapy, mechanical ventilation during the COVID-19 outbreak. Antimicrobial stewardship programs are required so that antibiotics are prescribed judiciously according to the culture results.