Pulmonary Co-Infections Detected Premortem Underestimate Postmortem Findings in a COVID-19 Autopsy Case Series-Reference-Cited by-同舟云学术

Pulmonary Co-Infections Detected Premortem Underestimate Postmortem Findings in a COVID-19 Autopsy Case Series

Published:2023-07-12 Issue:7 Volume:12 Page:932
ISSN:2076-0817
Container-title:Pathogens
language:en
Short-container-title:Pathogens

Author:

Platt Andrew P.¹²,Bradley Benjamin T.³^ORCID,Nasir Nadia⁴,Stein Sydney R.¹²,Ramelli Sabrina C.⁴^ORCID,Ramos-Benitez Marcos J.¹²⁵,Dickey James M.¹²,Purcell Madeleine⁶,Singireddy Shreya⁶,Hays Nicole⁶,Wu Jocelyn⁶,Raja Katherine⁶^ORCID,Curto Ryan⁶,Salipante Stephen J.⁷,Chisholm Claire⁷,Carnes Stephanie⁸,Marshall Desiree A.⁷,Cookson Brad T.⁷,Vannella Kevin M.¹²,Madathil Ronson J.⁹,Soherwardi Shahabuddin¹⁰^ORCID,McCurdy Michael T.⁶¹¹^ORCID,Saharia Kapil K.¹²,Rabin Joseph¹³,Grazioli Alison¹⁴,Kleiner David E.⁴,Hewitt Stephen M.⁴,Lieberman Joshua A.⁷^ORCID,Chertow Daniel S.¹²^ORCID,

Affiliation:

1. Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA

2. Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA

3. Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA

4. Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA

5. Department of Basic Sciences, Division of Microbiology, Ponce Research Institute, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA

6. University of Maryland School of Medicine, Baltimore, MD 21201, USA

7. Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA

8. American Esoteric Laboratories, Memphis, TN 38134, USA

9. Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA

10. Hospitalist Department, TidalHealth Peninsula Regional, Salisbury, MD 21801, USA

11. Department of Medicine, University of Maryland St. Joseph Medical Center, Towson, MD 21204, USA

12. Institute of Human Virology, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD 21201, USA

13. R Adams Cowley Shock Trauma Center, Department of Surgery and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA

14. R Adams Cowley Shock Trauma Center, Department of Medicine and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA

Abstract

Bacterial and fungal co-infections are reported complications of coronavirus disease 2019 (COVID-19) in critically ill patients but may go unrecognized premortem due to diagnostic limitations. We compared the premortem with the postmortem detection of pulmonary co-infections in 55 fatal COVID-19 cases from March 2020 to March 2021. The concordance in the premortem versus the postmortem diagnoses and the pathogen identification were evaluated. Premortem pulmonary co-infections were extracted from medical charts while applying standard diagnostic definitions. Postmortem co-infection was defined by compatible lung histopathology with or without the detection of an organism in tissue by bacterial or fungal staining, or polymerase chain reaction (PCR) with broad-range bacterial and fungal primers. Pulmonary co-infection was detected premortem in significantly fewer cases (15/55, 27%) than were detected postmortem (36/55, 65%; p < 0.0001). Among cases in which co-infection was detected postmortem by histopathology, an organism was identified in 27/36 (75%) of cases. Pseudomonas, Enterobacterales, and Staphylococcus aureus were the most frequently identified bacteria both premortem and postmortem. Invasive pulmonary fungal infection was detected in five cases postmortem, but in no cases premortem. According to the univariate analyses, the patients with undiagnosed pulmonary co-infection had significantly shorter hospital (p = 0.0012) and intensive care unit (p = 0.0006) stays and significantly fewer extra-pulmonary infections (p = 0.0021). Bacterial and fungal pulmonary co-infection are under-recognized complications in critically ill patients with COVID-19.

Funder

Intramural Research Program of the National Institutes of Health, Clinical Center

National Institute of Dental and Craniofacial Research

National Institute of Allergy and Infectious Diseases

NIH Medical Research Scholars Program

Doris Duke Charitable Foundation

Genentech

American Association for Dental Research

Colgate-Palmolive Company

Publisher

MDPI AG

Subject