학술논문
Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study
Document Type
article
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. 9(3)
Subject
Language
Abstract
BackgroundThe 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.MethodsWe 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 within ±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.ResultsAmong 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.ConclusionsViral 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.