Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study - 26/08/21
Doi : 10.1016/j.jinf.2021.07.014
C. Gudiol a, b, ag, ⁎, 1 
, X. Durà-Miralles a, ag, 1, J. Aguilar-Company c, P. Hernández-Jiménez d, M. Martínez-Cutillas e, F. Fernandez-Avilés f, M. Machado g, L. Vázquez h, P. Martín-Dávila i, N. de Castro j, E. Abdala k, L. Sorli l, T.M. Andermann m, I. Márquez-Gómez n, H. Morales o, F. Gabilán p, C.M. Ayaz q, B. Kayaaslan r, M. Aguilar-Guisado s, F. Herrera t, C. Royo-Cebrecos u, M. Peghin v, C. González-Rico w, J. Goikoetxea x, C. Salgueira y, A. Silva-Pinto z, B. Gutiérrez-Gutiérrez aa, S. Cuellar ab, G. Haidar ac, C. Maluquer ad, M. Marin ae, N. Pallarès af, J. Carratalà a, ag
, X. Durà-Miralles a, ag, 1, J. Aguilar-Company c, P. Hernández-Jiménez d, M. Martínez-Cutillas e, F. Fernandez-Avilés f, M. Machado g, L. Vázquez h, P. Martín-Dávila i, N. de Castro j, E. Abdala k, L. Sorli l, T.M. Andermann m, I. Márquez-Gómez n, H. Morales o, F. Gabilán p, C.M. Ayaz q, B. Kayaaslan r, M. Aguilar-Guisado s, F. Herrera t, C. Royo-Cebrecos u, M. Peghin v, C. González-Rico w, J. Goikoetxea x, C. Salgueira y, A. Silva-Pinto z, B. Gutiérrez-Gutiérrez aa, S. Cuellar ab, G. Haidar ac, C. Maluquer ad, M. Marin ae, N. Pallarès af, J. Carratalà a, ag a Department of Infectious Diseases, Biostatistics Unit, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, Barcelona, Spain
b Institut Català d'Oncologia, IDIBELL, University of Barcelona, Barcelona, Spain
c Department of Medical Oncology and Department of Infectious Diseases, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
d Infectious Diseases Unit, 12 de Octubre University Hospital, Madrid, Spain
e Medical Oncology Department, Puerta de Hierro University Hospital, Madrid, Spain
f Bone Marrow Transplantation Unit, Department of Haematology, Hospital Clinic of Barcelona, Spain
g Clinical Microbiology and Infectious Diseases Department. Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
h Hematology Department, Salamanca University Hospital, Spain
i Infectious Diseases Department, Ramony Cajal University Hospital, Madrid, Spain
j Infectious Diseases Department, St-Louis Hospital, University of Paris, France
k Faculdade de Medicina da Universidade de Sao Paulo, Instituto do Cancer do Estado de Sao Paulo, Brazil
l Infectious Diseases Service, Hospital del Mar. Infectious Pathology and Antimicrobials Research Group (IPAR), CEXS-Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
m Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
n Regional Málaga University Hospital, Málaga, Spain
o Hospital Erasto Gaertner, Curitiba, Brazil
p Infectious Diseases Department, Reina Sofía University Hospital, Córdoba, Spain
q Hacetteppe University Hospital, Ankara, Turkey
r Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Turkey
s Infectious Diseases Department, Virgen del Rocío University Hospital, Seville, Spain
t Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
u Nostra Senyora de Meritxell Hospital, Andorra
v Infectious Diseases Department, Santa María Misericordia, Udine, Italy
w Infectious Diseases Service, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain
x Infectious Diseases Department, Cruces University Hospital, Bilbao, Spain
y Sanatorio Anchorena, Buenos Aires, Argentina
z Infectious Diseases Intensive Care Unit, Centro Hospitalario Universitário de São João, Porto, Portugal
aa Infectious Diseases and Clinical Microbiology, Virgen de Macarena University Hospital, Institute of Biomedicine de Seville, University of Seville, Spain
ab Bone Marrow Transplant Unit, Hospital Rossi, La Plata, Argentina
ac Division of Infectious Diseases, University of Pittsburgh and UPMC, Pittsburgh, United States
ad Hematology Department, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
ae Oncology Department, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
af Biostatistics Unit, IDIBELL, Barcelona, Spain
ag Spainsh Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
⁎Corresponding author at: Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, Barcelona, Spain.Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), University of BarcelonaBarcelonaSpain
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Abstract |
Background |
We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19.
Methods |
International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections.
Results |
684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections.
Conclusions |
Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized.
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| COVICAN study group: Albasanz-Puig A, Bergas A, Maristany M, Antonio M, Laporte-Amargos J, Domingo-Domenech E and Molina K, Bellvitge University Hospital and Intitut Català d'Oncologia, IDIBELL, Barcelona, Spain. Ruiz-Camps I and Cabirta A, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. Aguado JM, 12 de Octubre University Hospital, Madrid, Spain. Fernández-Cruz A and Prieto-Martínez P, Puerta de Hierro University Hospital, Madrid, Spain. Marcos-Maeso MA, Cruz-Sequeiros C, Oliver-Caldes A, Martínez-Roca A, Hospital Clínic of Barcelona. Institut of Global Health (ISGlobal) and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Kwon M and Bailén R, Gregorio Marañón General University Hospital, Madrid, Spain. Fortún J, Infectious Diseases Department, Ramon y Cajal University Hospital, Madrid, Spain. Tatéo M and Molina JM, Infectious Diseases Department, St-Louis Hospital, University of Paris. Gonçalves Kono Magri AS and Keiko de Luca Ito RK, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Brazil. Montero MM and Gómez-Junyent J, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CEXS-Universitat Pompeu Fabra, Barcelona, Spain. Van Duin D and Merenbloom C, University of North Carolina at Chapel Hill, Department of Medicine, Division of Infectious Diseases, Chapel Hill, North Carolina, USA. Akova M and Duran ZC, Hacetteppe University Hospital, Ankara, Turkey. Akca N, Ankara Yildirim Beyazit University, Ankara City Hospital, Turkey. Castaldo N and Tascini C, Santa María Misericordia, Udine, Italy. Fariñas MC and Bermúdez A, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain. Bereciartua E, Cruces University Hospital, Bilbao, Spain. Altclas J and Fernandez M, Sanatorio Anchorena, Buenos Aires, Argentina. Santos L, Centro Hospitalario Universitário de São João, Porto, Portugal. Moreno-Mellado E, Virgen de Macarena University Hospital, Institute of Biomedicine de Seville; University of Seville, Spain. Malacalza J and Naretti JP, Bone Marrow Transplant Unit, Hospital Rossi, La Plata, Argentina. Hughes K, Division of Infectious Diseases, University of Pittsburgh and UPMC, Pittsburgh, USA. Tebe C, Biostatistics Unit, IDIBELL, Barcelona, Spain. |
© 2021
Publié par Elsevier Masson SAS.
Vol 83 - N° 3
P. 306-313 - septembre 2021 Retour au numéro
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