Coinfections and superinfections in critically ill COVID-19 patients in Ecuador: a cross-sectional study of bacterial and viral pathogens

Introduction The COVID-19 pandemic has deeply affected Latin America and Ecuador. Coinfections and superinfections increase the risk of morbidity and mortality in COVID-19 patients. This study examined co-infections and superinfections in critically ill COVID-19 patients admitted to the ICU of a tertiary hospital in Ecuador. Methods A cross-sectional study was conducted from February to August 2021, including patients with a confirmed SARS-CoV-2 infection. Demographic data, clinical characteristics, and microbiological findings were analyzed to evaluate the presence of coinfections and superinfections. Results A total of 24 patients were included, of whom 70.83% (17/24) experienced either coinfection or superinfection. Community-acquired coinfections were identified in 12.5% (3/24) of patients, whereas hospital-acquired superinfections were detected in 58.3% (14/24). The most frequently isolated pathogens were Klebsiella pneumoniae , Staphylococcus aureus , and Enterococcus faecalis . Molecular testing revealed Streptococcus pneumoniae was the most prevalent organism. Bloodstream infections were the most common superinfections, with an attack rate of 92.8% (13/14). The median time from hospital admission to superinfection diagnosis was 5 days. The study also found that 33% (8/24) of patients died, all of whom were men; 62% (5/8) of the patients who died have superinfection. However, infections were not identified as independent predictors of death, given the small cohort size ( n = 24) and descriptive statistical design. Discussion These findings underscore the importance of robust monitoring of co-infections and superinfections in critically ill COVID-19 patients, especially in resource-limited settings. The high prevalence of these infections highlights the need for continued investment in microbiological surveillance, rapid diagnostics, and antimicrobial stewardship programs to mitigate long-term consequences and address the increasing threat of antimicrobial resistance.