Authors: Bassetti M, Kollef MH, Timsit JF
PMID: 32902729 PMCID: PMC7479998 DOI: 10.1007/s00134-020-06219-8
Abstract
Are critically ill patients with coronavirus disease 2019 (COVID-19) at high risk of bacterial and fungal superinfections developing on the top of the viral infection in the lung or in other body sites? And from which organisms? Answering these apparently simple questions could be far more difficult than expected, for at least three important reasons.
The first one is that the timing of development of superinfection (early or late) with respect to the intensive care unit (ICU) admission may have relevant clinical implications. Indeed, borrowing from experiences in other ICU populations it cannot be excluded a priori that early and late superinfections may be profoundly different in terms of risk. However, early and late superinfections have been frequently lumped together in the currently available literature on COVID-19 patients, making it difficult to firmly grasp their separate risks. The second reason is that the high case fatality of the viral disease per se may be an important competing risk for the development of late superinfection, which may lead to an unintended underestimation of the risk of superinfection at the bedside of alive patients. The third reason specifically involves invasive aspergillosis, for which the current absence of a standardized definition for non-proven disease in non-neutropenic critically ill patients may preclude a reliable risk assessment also in COVID-19 patients. In the next few paragraphs, we briefly discuss each of these three intertwined, important issues.
Keywords: fungal infection, bacterial infection, COVID-19
