Incidence of co-infections and superinfections in hospitalised patients with COVID-19: a retrospective cohort study.

OBJECTIVES: We aimed to describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalised patients with COVID-19. METHODS: Observational cohort study of all consecutive patients admitted ≥ 48 hours to Hospital Clinic of Barcelona for COVID-19 (February 28th - April 22nd, 2020) who are currently discharged or dead. We describe demographic, epidemiologic, laboratory, and microbiologic results, as well as outcome data retrieved from electronic health records. RESULTS: Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74, bacterial; 7, fungal and 7, viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31 out of 989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 (4.7%) patients, with a mean time from hospital admission to superinfection diagnosis of 10.6 (SD 6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections presented with worse outcomes. CONCLUSIONS: Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalisation. These findings are quite differential when compared with those of other viral pandemics. As it relates to hospitalised patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies.