Coinfections in intensive care units. Has anything changed with Covid-19 pandemia?

Coinfections in intensive care units. Has anything changed with Covid-19 pandemia?


  • Federica Romanelli a:1:{s:5:"en_US";s:115:"1Section of Microbiology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy";}
  • Stefania Stolfa
  • Luigi Ronga
  • Raffaele Del Prete
  • Davide Fiore Bavaro
  • Annalisa Saracino
  • Lidia Dalfino
  • Adriana Mosca


COVID-19, coinfection, epidemiology


Background and aim: Since December 2019, the Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), has spread from China, becoming a pandemic. Bacterial and fungal co-infections may lead to increase in COVID-19 severity with a decrease in patients survive. The aim of this work was to evaluate bacterial and fungal co-infections in COVID-19 patients admitted to ICU in comparison with patients recovered in ICU in pre-COVID-19 era in order to understand whether the pandemic had changed the incidence of overinfections in patients admitted to ICU. In fact, the epidemiological data should guide the choice of empirical therapy. Methods: During pandemic, AOUC Policlinico of Bari organized dedicated ICUs for patient with SARS-CoV-2. Blood cultures, urine, and tracheobronchial aspirate were included in the analysis. Results: Specimens of 1905 patients were analysed in this work. Comparing clinical isolates prevalence by material and COVID-19 vs. non-COVID-19 patients statistically significant differences were detected for A. baumannii complex, Aspergillus fumigatus, Escherichia coli, Haemophilus influenzae and Serratia marcescens isolated from tracheobronchial aspirates; C. albicans from urine samples, A. baumannii complex, Enterococcus faecalis and Enterococcus faecium isolated from blood culture. Conclusions: Although the organisms isolated in COVID-19 patients are consistent with those frequently associated with healthcare associated infection, our data suggest a particular prevalence in COVID-19 patients of A. baumannii, Stenotrophomonas maltophilia and Aspergillus spp. in the respiratory tract, C. albicans in urine and  A. baumannii, E. faecalis and E. faecium in blood cultures.


Lansbury L, Lim B, Baskaran V, et al. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266–275.

Fattorini L, Creti R, Palma C, et al. Bacterial coinfections in COVID-19: an underestimated adversary. DOI: 10.4415/ANN_20_03_14

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: 10.1016/S0140- 6736(20)30566-3

Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, Peng Z, Pan H. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020; 127:104364. doi: 10.1016/j.jcv.2020.104364.

Salvatore Mangiafico (2021). rcompanion: Functions to Support Extension Education Program Evaluation. R package version 2.4.1.

R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL

Mahmoudi H. Bacterial co-infections and antibiotic resistance in patients with COVID-19. GMS Hyg Infect Control. 2020;15.

Sharifipour E, Shams S, Esmkhani M, Khodadadi J, Fotouhi-Ardakani R, Koohpaei A, Doosti Z, Golzari SE. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis. 2020;20(1):1–7.

Temperoni C, Caiazzo L, Barchiesi F. High prevalence of antibiotic resistance among opportunistic pathogens isolated from patients with COVID-19 under mechanical ventilation: results of a single-center study. Antibiotics. 2021;10(9):1080.

Mazzariol A, Benini A, Unali I, Nocini R, Smania M, Bertoncelli A, De Sanctis F, Ugel S, Donadello K, Polati E. Dynamics of SARS-CoV2 infection and multi-drug resistant bacteria superinfection in patients with assisted mechanical ventilation. Front Cell Infect Microbiol. 2021;12(11):683409

Nori, Priya et al. “Bacterial and fungal coinfections in COVID-19 patients hospitalized during the New York City pandemic surge.” Infection control and hospital epidemiology vol. 42,1 (2021): 84-88. doi:10.1017/ice.2020.368

Gil E, Martyn E, Rokadiya S, Jain S, Chin TL. Bacterial Coinfection in COVID-19. Clin Infect Dis. 2021;73(3): e843-e845. doi:10.1093/cid/ciaa1120

Sepulveda J, Westblade LF, Whittier S, Satlin MJ, Greendyke WG, Aaron JG, Zucker J, Dietz D, Sobieszczyk M, Choi JJ, Liu D, Russell S, Connelly C, Green DA. Bacteremia and Blood Culture Utilization during COVID-19 Surge in New York City. J Clin Microbiol. 2020 Jul 23;58(8):e00875-20. doi: 10.1128/JCM.00875-20. PMID: 32404482; PMCID: PMC7383550.

van Arkel, A., Rijpstra, T. A., Belderbos, H., van Wijngaarden, P., Verweij, P. E., & Bentvelsen, R. G. (2020). COVID-19-associated Pulmonary Aspergillosis. American journal of respiratory and critical care medicine, 202(1), 132–135.

Koehler P, Cornely OA, Böttiger BW, et al. COVID-19 associated pulmonary aspergillosis. Mycoses 2







How to Cite

Romanelli F, Stolfa S, Ronga L, Del Prete R, Bavaro DF, Saracino A, et al. Coinfections in intensive care units. Has anything changed with Covid-19 pandemia? . Acta Biomed [Internet]. 2023 Jun. 14 [cited 2024 Jul. 20];94(3):e2023075. Available from: