학술논문
Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study
MAJOR ARTICLE
MAJOR ARTICLE
Document Type
Academic Journal
Author
Satyanarayana, Gowri; Enriquez, Kyle T.; Sun, Tianyi; Klein, Elizabeth J.; Abidi, Maheen; Advani, Shailesh M.; Awosika, Joy; Bakouny, Ziad; Bashir, Babar; Berg, Stephanie; Bernardes, Marilia; Egan, Pamela C.; Elkrief, Arielle; Feldman, Lawrence E.; Friese, Christopher R.; Goel, Shipra; Gomez, Cyndi Gonzalez; Grant, Keith L.; Griffiths, Elizabeth A.; Gulati, Shuchi; Gupta, Shilpa; Hwang, Clara; Jain, Jayanshu; Jani, Chinmay; Kaltsas, Anna; Kasi, Anup; Khan, Hina; Knox, Natalie; Koshkin, Vadim S.; Kwon, Daniel H.; Labaki, Chris; Lyman, Gary H.; McKay, Rana R.; McNair, Christopher; Nagaraj, Gayathri; Nakasone, Elizabeth S.; Nguyen, Ryan; Nonato, Taylor K.; Olszewski, Adam J.; Panagiotou, Orestis A.; Puc, Matthew; Razavi, Pedram; Robilotti, Elizabeth V.; Santos-Dutra, Miriam; Schmidt, Andrew L.; Shah, Dimpy P.; Shah, Sumit A.; Vieira, Kendra; Weissmann, Lisa B.; Wise-Draper, Trisha M.; Wu, Ulysses; Wu, Julie Tsu-Yu; Choueiri, Toni K.; Mishra, Sanjay; Warner, Jeremy L.; French, Benjamin; Farmakiotis, Dimitrios
Source
Open Forum Infectious Diseases. March 2022, Vol. 9 Issue 3
Subject
Language
English
ISSN
2328-8957
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), has infected >288 million people and contributed to >5.4 million deaths globally [1]. Among patients [...]
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 ([greater than or equal to] 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 within [+ or -] 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. Keywords. bacterial infections; CAPA (COVID-19-associated pulmonary aspergillosis); COVID-19; mucormycoses; viral infections.
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 ([greater than or equal to] 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 within [+ or -] 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. Keywords. bacterial infections; CAPA (COVID-19-associated pulmonary aspergillosis); COVID-19; mucormycoses; viral infections.