TY - JOUR
T1 - Coinfections in Patients with Cancer and COVID-19
T2 - A COVID-19 and Cancer Consortium (CCC19) Study
AU - Satyanarayana, Gowri
AU - Enriquez, Kyle T.
AU - Sun, Tianyi
AU - Klein, Elizabeth J.
AU - Abidi, Maheen
AU - Advani, Shailesh M.
AU - Awosika, Joy
AU - Bakouny, Ziad
AU - Bashir, Babar
AU - Berg, Stephanie
AU - Bernardes, Marilia
AU - Egan, Pamela C.
AU - Elkrief, Arielle
AU - Feldman, Lawrence E.
AU - Friese, Christopher R.
AU - Goel, Shipra
AU - Gomez, Cyndi Gonzalez
AU - Grant, Keith L.
AU - Griffiths, Elizabeth A.
AU - Gulati, Shuchi
AU - Gupta, Shilpa
AU - Hwang, Clara
AU - Jain, Jayanshu
AU - Jani, Chinmay
AU - Kaltsas, Anna
AU - Kasi, Anup
AU - Khan, Hina
AU - Knox, Natalie
AU - Koshkin, Vadim S.
AU - Kwon, Daniel H.
AU - Labaki, Chris
AU - Lyman, Gary H.
AU - McKay, Rana R.
AU - McNair, Christopher
AU - Nagaraj, Gayathri
AU - Nakasone, Elizabeth S.
AU - Nguyen, Ryan
AU - Nonato, Taylor K.
AU - Olszewski, Adam J.
AU - Panagiotou, Orestis A.
AU - Puc, Matthew
AU - Razavi, Pedram
AU - Robilotti, Elizabeth V.
AU - Santos-Dutra, Miriam
AU - Schmidt, Andrew L.
AU - Shah, Dimpy P.
AU - Shah, Sumit A.
AU - Vieira, Kendra
AU - Weissmann, Lisa B.
AU - Wise-Draper, Trisha M.
AU - Wu, Ulysses
AU - Wu, Julie Tsu Yu
AU - Choueiri, Toni K.
AU - Mishra, Sanjay
AU - Warner, Jeremy L.
AU - French, Benjamin
AU - Farmakiotis, Dimitrios
N1 - Publisher Copyright:
© 2022 The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2022/3
Y1 - 2022/3
N2 - Background: The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods: We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections withinâ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results: Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33-1.95) and fungal (OR, 2.20; 95% CI, 1.28-3.76) coinfections. Conclusions: Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.
AB - Background: The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods: We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections withinâ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results: Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33-1.95) and fungal (OR, 2.20; 95% CI, 1.28-3.76) coinfections. Conclusions: Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.
KW - CAPA (COVID-19-Associated pulmonary aspergillosis)
KW - COVID-19
KW - bacterial infections
KW - mucormycoses
KW - viral infections
UR - http://www.scopus.com/inward/record.url?scp=85126341553&partnerID=8YFLogxK
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U2 - 10.1093/ofid/ofac037
DO - 10.1093/ofid/ofac037
M3 - Article
C2 - 35198648
AN - SCOPUS:85126341553
SN - 2328-8957
VL - 9
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 3
M1 - ofac037
ER -