The frequency of coinfections in patients with coronavirus disease 2019 in intensive care units: Meta-analysis

Background: Patients with coronavirus disease 2019 (COVID19) who require intensive care are vulnerable to additional infectious complications during hospitalization. This review evaluated the frequency and microbiological profile of coinfections reported in intensive care unit (ICU)admitted patients with COVID19. Materials and Methods: A systematic search was performed in electronic databases for studies published between December 1, 2019, and January 31, 2021. Eligible studies were assessed using the National Institutes of Health quality assessment tools. Quantitative analyses were conducted with Stata version 17. Results: Among 160 retrieved records, 74 studies were eligible for qualitative synthesis, while 42 items provided sufficient data for metaanalysis. The pooled prevalence of coinfection was 35%. Bacterial infections were estimated at 12%, fungal infections at 11%, and viral infections at 5%, while mixedpathogen infections accounted for 16%. Coinfection was more frequent in men than women, with pooled estimates of 69% and 31%, respectively (P < 0.001). No significant association was detected between age and coinfection prevalence (P = 0.65). In ICUtreated patients with COVID19, bacterial pathogens were the leading cause of coinfection, followed by fungal and viral agents. Conclusion: These findings support careful microbiological evaluation in critically ill patients, particularly when clinical deterioration occurs. Early pathogen identification may help guide antimicrobial therapy, reduce unnecessary broadspectrum treatment, and improve clinical outcomes.