{"id":94186,"date":"2021-11-04T10:03:36","date_gmt":"2021-11-04T14:03:36","guid":{"rendered":"http:\/\/stateofthenation.co\/?p=94186"},"modified":"2021-11-04T10:06:56","modified_gmt":"2021-11-04T14:06:56","slug":"bacterial-and-fungal-infections-in-covid-19-patients-a-matter-of-concern","status":"publish","type":"post","link":"https:\/\/stateofthenation.co\/?p=94186","title":{"rendered":"Bacterial and fungal infections in COVID-19 patients: A matter of concern"},"content":{"rendered":"<p><!--more--><\/p>\n<div id=\"maincontent\" class=\"col\" data-v-2042ca1c=\"\" data-v-780758a7=\"\">\n<div class=\"row part-of\" data-v-2042ca1c=\"\"><span class=\"part-of__label\" data-v-2042ca1c=\"\">Part of:<\/span><a class=\"part-of__collection\" href=\"https:\/\/www.cambridge.org\/core\/product\/identifier\/ICE_COVID_MASTER_PACKAGE\/type\/BESPOKE_COLLECTION\" target=\"_blank\" rel=\"noopener\" data-v-69588964=\"\" data-v-2042ca1c=\"\">SARS-CoV-2\/COVID-19<\/a><\/div>\n<div class=\"row published-date\" data-v-2042ca1c=\"\">\n<p data-v-2042ca1c=\"\">Published online by Cambridge University Press:\u00a0\u00a0<strong data-v-2042ca1c=\"\">22 April 2020<\/strong><\/p>\n<\/div>\n<div class=\"contributors-details\" data-v-9b9ffd3e=\"\" data-v-2042ca1c=\"\">\n<div class=\"row contributors\" data-v-9b9ffd3e=\"\">\n<div class=\"col\" data-v-9b9ffd3e=\"\">\n<div class=\"row contributor-type\" data-v-3d01afaa=\"\" data-v-9b9ffd3e=\"\">\n<div class=\"contributor-type__contributor\" data-v-3d01afaa=\"\"><a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/www.cambridge.org\/core\/search?filters%5BauthorTerms%5D=Pengcheng%20Zhou&amp;eventCode=SE-AU\" data-v-1b245387=\"\" data-v-3d01afaa=\"\"><span data-v-1b245387=\"\">Pengcheng Zhou<\/span><\/a><span data-v-3d01afaa=\"\">, <\/span><a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/www.cambridge.org\/core\/search?filters%5BauthorTerms%5D=Zhenguo%20Liu&amp;eventCode=SE-AU\" data-v-1b245387=\"\" data-v-3d01afaa=\"\"><span data-v-1b245387=\"\">Zhenguo Liu<\/span><\/a><span data-v-3d01afaa=\"\">, <\/span><a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/www.cambridge.org\/core\/search?filters%5BauthorTerms%5D=Yuhua%20Chen&amp;eventCode=SE-AU\" data-v-1b245387=\"\" data-v-3d01afaa=\"\"><span data-v-1b245387=\"\">Yuhua Chen<\/span><\/a><span data-v-3d01afaa=\"\">, <\/span><a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/www.cambridge.org\/core\/search?filters%5BauthorTerms%5D=Yinzong%20Xiao&amp;eventCode=SE-AU\" data-v-1b245387=\"\" data-v-3d01afaa=\"\"><span data-v-1b245387=\"\">Yinzong Xiao<\/span><\/a><span data-v-3d01afaa=\"\">, <\/span><a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/www.cambridge.org\/core\/search?filters%5BauthorTerms%5D=Xun%20Huang&amp;eventCode=SE-AU\" data-v-1b245387=\"\" data-v-3d01afaa=\"\"><span data-v-1b245387=\"\">Xun Huang<\/span><\/a><span data-v-3d01afaa=\"\">\u00a0and <\/span><a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/www.cambridge.org\/core\/search?filters%5BauthorTerms%5D=Xue-Gong%20Fan&amp;eventCode=SE-AU\" data-v-1b245387=\"\" data-v-3d01afaa=\"\"><span data-v-1b245387=\"\">Xue-Gong Fan<\/span><\/a><\/div>\n<\/div>\n<\/div>\n<div class=\"col-2 collapse-link\" data-v-9b9ffd3e=\"\"><a class=\"app-link collapsed app-link__text-icon app-link--secondary reverse\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#authors-details\" data-v-1b245387=\"\" data-v-9b9ffd3e=\"\" data-toggle=\"collapse\" aria-expanded=\"false\" aria-controls=\"authors-details\"><img decoding=\"async\" class=\"app-icon icon arrow-down\" 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As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the \u2018Save PDF\u2019 action button.<\/div>\n<\/div>\n<\/div>\n<hr class=\"separator default\" data-v-27381116=\"\" data-v-61523442=\"\" aria-hidden=\"true\" \/>\n<\/div>\n<\/div>\n<div class=\"row\" data-v-2957dcf9=\"\">TypeLetter to the Editor<\/div>\n<div class=\"row\" data-v-2957dcf9=\"\">\n<p>Information<\/p>\n<div class=\"content__journal\" data-v-2957dcf9=\"\"><a class=\"app-link app-link__text app-link--underlined\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\" data-v-1b245387=\"\" data-v-2957dcf9=\"\"><span class=\"text\" data-v-1b245387=\"\">Infection Control &amp; Hospital Epidemiology<\/span><\/a>\u00a0<span data-v-2957dcf9=\"\">,\u00a0<a class=\"app-link app-link__text app-link--underlined\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/volume\/252ECD8D98BAC4A9C8BE61089C35A572\" data-v-1b245387=\"\" data-v-2957dcf9=\"\"><span class=\"text\" data-v-1b245387=\"\">Volume 41<\/span><\/a><\/span>\u00a0<span data-v-2957dcf9=\"\">,\u00a0<a class=\"app-link app-link__text app-link--underlined\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/issue\/28330198E84B2E3D0D2B15DA472597A9\" data-v-1b245387=\"\" data-v-2957dcf9=\"\"><span class=\"text\" data-v-1b245387=\"\">Issue 9<\/span><\/a><\/span>\u00a0<span data-v-2957dcf9=\"\">, September 2020<\/span>\u00a0<span data-v-2957dcf9=\"\">, pp. 1124 &#8211; 1125<\/span><\/div>\n<div class=\"doi-data\" data-v-2957dcf9=\"\">\n<div data-v-2957dcf9=\"\">DOI:\u00a0<a class=\"app-link app-link__text app-link--accent\" href=\"https:\/\/doi.org\/10.1017\/ice.2020.156\" target=\"_blank\" rel=\"noopener\" data-v-1b245387=\"\" data-v-2957dcf9=\"\"><span class=\"text\" data-v-1b245387=\"\">https:\/\/doi.org\/10.1017\/ice.2020.156<\/span><span class=\"sr-only\" data-v-1b245387=\"\">[Opens in a new window]<\/span><\/a><\/div>\n<p><a class=\"crossmark-widget\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#\" data-v-2957dcf9=\"\" data-target=\"crossmark\" aria-label=\"Check for updates\"><img decoding=\"async\" src=\"https:\/\/www.cambridge.org\/core\/page-component\/img\/crossmark-logo.a6fa1ee.svg\" alt=\"Check for updates\" data-v-2957dcf9=\"\" \/><\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"row\" data-v-2957dcf9=\"\">\n<p>Creative Commons<\/p>\n<div class=\"creative-commons\" data-v-2957dcf9=\"\">\n<div class=\"creative-commons__icons\"><img decoding=\"async\" class=\"app-icon creative-commons__icon license-cc\" src=\"https:\/\/www.cambridge.org\/core\/page-component\/img\/license-cc-icon.015e93c.svg\" alt=\"Creative Common License - CC\" data-v-78cc1601=\"\" \/><img decoding=\"async\" class=\"app-icon creative-commons__icon license-by\" src=\"https:\/\/www.cambridge.org\/core\/page-component\/img\/license-by-icon.9020332.svg\" alt=\"Creative Common License - BY\" data-v-78cc1601=\"\" \/><\/div>\n<div class=\"creative-commons__description\">This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (<a href=\"http:\/\/creativecommons.org\/licenses\/by\/4.0\/\" target=\"_blank\" rel=\"noopener\">http:\/\/creativecommons.org\/licenses\/by\/4.0\/<\/a>), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.<\/div>\n<\/div>\n<\/div>\n<div class=\"row\" data-v-2957dcf9=\"\">Copyright\u00a9 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.<\/div>\n<div id=\"content-container\" data-v-45ebe59a=\"\">\n<div class=\"content-box\">\n<div class=\"article letter NLM\">\n<div class=\"body\">\n<p class=\"p\"><em class=\"italic\">To the Editor\u2014<\/em>Coronavirus disease 2019 (COVID-19) has become a pandemic. As of April 2, 2020, a total of 896,450 laboratory-confirmed cases have been reported. The death toll from COVID-19 has soared quickly: 45,526 deaths have been reported globally, including 24,692 deaths in only a week (March 26, 2020, through April 2, 2020).<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r1\">1<\/a><\/sup>\u00a0Age, sequential organ failure assessment (SOFA) score, and D-dimer are the main prognostic factors of COVID-19 patients.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r2\"><span class=\"show-for-sr\">Reference Zhou, Yu and Du<\/span>2<\/a><\/sup>\u00a0The presence of bacterial and\/or fungal secondary infection or coinfection is likely another important factor affecting mortality, and it has received inadequate attention.<\/p>\n<p class=\"p\">Bacterial and fungal infections are common complications of viral pneumonia, especially in critically ill patients. They lead to increased need for intensive care and increased mortality. In influenza patients, bacterial coinfection occurs in ~0.5% of healthy young individuals and at least 2.5% of older individuals.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r3\"><span class=\"show-for-sr\">Reference Chertow and Memoli<\/span>3<\/a><\/sup>\u00a0A systematic review revealed that ~1 in 4 H1N1 patients during the 2009 pandemic had a bacterial or fungi infection infection.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r4\"><span class=\"show-for-sr\">Reference MacIntyre, Chughtai and Barnes<\/span>4<\/a><\/sup>\u00a0Data regarding the bacterial or fungi infection in viral pneumonia led by coronavirus are limited. According to the cohort study report by Zhong Nanshan et al,<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r5\"><span class=\"show-for-sr\">Reference Zheng, Chen and Li<\/span>5<\/a><\/sup>\u00a020 of 90 severe acute respiratory syndrome (SARS) patients had secondary lower respiratory tract infections in 2003, which accounted for 70.6% of those critical SARS patients who underwent an invasive operation. The pathogens causing secondary infections in SARS patients were diverse: negative bacilli were the most common but\u00a0<em class=\"italic\">Candida<\/em>\u00a0was also common.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r5\"><span class=\"show-for-sr\">Reference Zheng, Chen and Li<\/span>5<\/a><\/sup>\u00a0Invasive pulmonary aspergillosis was another common complication secondary to influenza.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r6\"><span class=\"show-for-sr\">Reference Rijnders, Schauwvlieghe and Wauters<\/span>6<\/a><\/sup><\/p>\n<p class=\"p\">Bacterial and fungal infections in COVID-19 patients have been inadequately investigated and reported thus far. Among the hundreds of articles published with clinical data, only a few have reported secondary infection, mostly without detailed pathogens (Table\u00a0<a class=\"xref table\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#tbl1\">1<\/a>). Even in studies for which secondary infection data are available, the antibiotics use rate (94%\u2013100%) was much higher than the reported incidence of secondary infection (10%\u201315%).<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r2\"><span class=\"show-for-sr\">Reference Zhou, Yu and Du<\/span>2<\/a>,<a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r7\"><span class=\"show-for-sr\">Reference Huang, Wang, Li, Ren and Zhao<\/span>7<\/a>,<a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r8\"><span class=\"show-for-sr\">Reference Yang, Yu, Xu, Shu and Xia<\/span>8<\/a><\/sup>\u00a0In addition, the complication of bacterial or fungal infection was not included in the prognosis analysis in most published papers. Moreover, most of the current infection control protocols aim to prevent the transmission and cross infection by SARS-CoV-2, missing the prevention of bacterial or fungal secondary infection. In fact, secondary infection was found in 50% of nonsurviving COVID-19 patients.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r2\"><span class=\"show-for-sr\">Reference Zhou, Yu and Du<\/span>2<\/a><\/sup><\/p>\n<h2 class=\"A clr-fn-label\"><\/h2>\n<div id=\"tbl1\" class=\"table-wrap\" data-magellan-destination=\"tbl1\">\n<div class=\"caption\">\n<p class=\"p\"><span class=\"label\">Table 1.<\/span>\u00a0Secondary Infection or Coinfection in COVID-19 Patients<\/p>\n<\/div>\n<div class=\"figure-thumb\"><img loading=\"lazy\" decoding=\"async\" class=\"aop-lazy-load-image graphic\" src=\"https:\/\/static.cambridge.org\/binary\/version\/id\/urn:cambridge.org:id:binary:20200914191032052-0865:S0899823X20001567:S0899823X20001567_tab1.png?pub-status=live\" width=\"891\" height=\"150\" data-src=\"https:\/\/static.cambridge.org\/binary\/version\/id\/urn:cambridge.org:id:binary:20200914191032052-0865:S0899823X20001567:S0899823X20001567_tab1.png?pub-status=live\" data-original-image=\"urn:cambridge.org:id:binary:20200914191032052-0865:S0899823X20001567:S0899823X20001567_tab1.png\" data-zoomable=\"true\" data-img-name=\"Table 1.\" \/><button class=\"app-button app-button__icon app-button-- enlarge-image-icon\" data-v-562d1bc6=\"\" aria-label=\"Open Table 1. image in full screen\"><img decoding=\"async\" class=\"app-icon icon enlarge-image\" src=\"data:image\/svg+xml;base64,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\" alt=\"\" data-v-78cc1601=\"\" data-v-562d1bc6=\"\" \/><\/button><\/div>\n<div class=\"table-wrap-foot\">\n<p class=\"p\">Note. Patients were classified in to ICU and non-ICU patients instead of nonsurvivors and survivors in the study by Huang et al.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r7\"><span class=\"show-for-sr\">Reference Huang, Wang, Li, Ren and Zhao<\/span>7<\/a><\/sup><\/p>\n<\/div>\n<\/div>\n<p class=\"p\">Thus far, many diagnostic and prevention approaches to targeting complications in COVID-19 patients have been outlined in clinical guidelines in China. However, little attention has been given to secondary bacterial and fungal infections, and a standardized diagnostic process remains unavailable. A few challenges exist in diagnosing secondary infection in COVID-19 patients. Although it can be difficult to distinguish bacterial or fungal infection and existing viral pneumonia based on clinical and radiological appearance, microbiological examination can add great value to diagnoses, especially sputum culture. However, this approach can pose significant risks to biosample collectors and laboratory technicians processing samples from COVID-19 patients because the virus is transmitted via virus-laden aerosols in addition to respiratory droplets and direct contact.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r9\">9<\/a><\/sup>\u00a0Thus far, no standardized personal protection equipment (PPE) has been recommended in the guidelines in China for healthcare workers who process bacterial and fungal cultures.<sup class=\"sup\"><a class=\"xref bibr\" href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F#r10\">10<\/a><\/sup>\u00a0Other problems include insufficient laboratory biosafety conditions and PPE shortages. These conditions have led to most hospitals to decide not to carry out routine microbiological examination in COVID-19 patients, which undermines the diagnosis and treatment of secondary infection.<\/p>\n<p class=\"p\">Clinical data regarding bacterial and fungal infections are valuable in guiding evidence-based treatment of COVID-19. Thus, we call for strengthening the investigation of secondary infection and\/or coinfection in COVID-19 patients without risking laboratory staff safety. Health authorities and academic organizations need to include a practical diagnostic process for determining bacterial and fungal infection in COVID-19 patients. Furthermore, the biosafety requirements for COVID-19 microbiological laboratory staff should be issued, and personal protection guidelines for microbiological laboratory staff should be clear. Qualified medical institutions need to be encouraged to carry out necessary microbiological examinations. Thus, we will be able to study bacterial or fungal infections in COVID-19 patients in the following aspects: epidemiology (eg, infection sites, incidence rates, epidemic characteristics, risk factors, etc); pathogens and their drug sensitivity results, thus providing the theoretical and factual evidence for precise treatment; accurate prevention and control of infection complications; and effective reduction of the mortality of COVID-19 patients.<\/p>\n<\/div>\n<div class=\"back\">\n<div class=\"ack\">\n<h2 class=\"A\">Acknowledgments<\/h2>\n<\/div>\n<div id=\"s1\" class=\"sec other\" data-magellan-destination=\"s1\">\n<h2 class=\"A\">Financial support<\/h2>\n<p class=\"p\">This study was funded by the Emergency Project of Prevention and Control for COVID-19 of Central South University (grant no. 160260003).<\/p>\n<\/div>\n<div id=\"s2\" class=\"sec other\" data-magellan-destination=\"s2\">\n<h2 class=\"A\">Conflicts of interest<\/h2>\n<p class=\"p\">All authors report no conflicts of interest relevant to this article.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<hr class=\"list-divider separator default\" data-v-27381116=\"\" aria-hidden=\"true\" \/>\n<div id=\"references-list\" class=\"circle-list\">\n<h2>References<\/h2>\n<div id=\"ref1\" class=\"circle-list__item\" aria-flowto=\"reference-1-content reference-1-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">1<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-1-content\" class=\"circle-list__item__grouped__content\">COVID-19 situation report-73. World Health Organization website.\u00a0<a class=\"uri\" href=\"https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200402-sitrep-73-covid-19.pdf?sfvrsn=5ae25bc7_2\">https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200402-sitrep-73-covid-19.pdf?sfvrsn=5ae25bc7_2<\/a>. Published 2020. Accessed April 7, 2020.<a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=COVID-19+situation+report-73.+World+Health+Organization+website.+https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200402-sitrep-73-covid-19.pdf?sfvrsn=5ae25bc7_2.+Published+2020.+Accessed+April+7,+2020.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref2\" class=\"circle-list__item\" aria-flowto=\"reference-2-content reference-2-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">2<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-2-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">Zhou<\/span>,\u00a0<span class=\"given-names\">F<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Yu<\/span>,\u00a0<span class=\"given-names\">T<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Du<\/span>,\u00a0<span class=\"given-names\">R<\/span><\/span>,\u00a0<span class=\"etal\">et al.<\/span>\u00a0Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.\u00a0<em class=\"italic\">Lancet<\/em>\u00a0<span class=\"year\">2020<\/span>. doi:\u00a0<span class=\"pub-id doi\">10.1016\/S0140-6736(20)30566-3<\/span>.<a class=\"ref-link\" href=\"http:\/\/dx.doi.org\/10.1016\/S0140-6736(20)30566-3\" target=\"_blank\" rel=\"noopener\">CrossRef<\/a><a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=Zhou,+F,+Yu,+T,+Du,+R,+et+al.+Clinical+course+and+risk+factors+for+mortality+of+adult+inpatients+with+COVID-19+in+Wuhan,+China:+a+retrospective+cohort+study.+Lancet2020.+doi:+10.1016\/S0140-6736(20)30566-3.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref3\" class=\"circle-list__item\" aria-flowto=\"reference-3-content reference-3-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">3<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-3-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">Chertow<\/span>,\u00a0<span class=\"given-names\">DS<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Memoli<\/span>,\u00a0<span class=\"given-names\">MJ<\/span><\/span>.\u00a0<span class=\"article-title\">Bacterial coinfection in influenza: a grand rounds review<\/span>.\u00a0<span class=\"source\">JAMA<\/span>\u00a0<span class=\"year\">2013<\/span>;<span class=\"volume\">309<\/span>:<span class=\"fpage\">275<\/span>\u2013<span class=\"lpage\">282<\/span>.<a class=\"ref-link\" href=\"http:\/\/dx.doi.org\/10.1001\/jama.2012.194139\" target=\"_blank\" rel=\"noopener\">CrossRef<\/a><a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar_lookup?title=Bacterial+coinfection+in+influenza%3A+a+grand+rounds+review&amp;author=Chertow+DS&amp;author=Memoli+MJ&amp;publication+year=2013&amp;journal=JAMA&amp;volume=309&amp;doi=10.1001%2Fjama.2012.194139&amp;pages=275-282\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><a class=\"ref-link\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23321766\" target=\"_blank\" rel=\"noopener\">PubMed<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref4\" class=\"circle-list__item\" aria-flowto=\"reference-4-content reference-4-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">4<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-4-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">MacIntyre<\/span>,\u00a0<span class=\"given-names\">CR<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Chughtai<\/span>,\u00a0<span class=\"given-names\">AA<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Barnes<\/span>,\u00a0<span class=\"given-names\">M<\/span><\/span>,\u00a0<span class=\"etal\">et al.<\/span><span class=\"article-title\">The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09<\/span>.\u00a0<span class=\"source\">BMC Infect Dis<\/span>\u00a0<span class=\"year\">2018<\/span>;<span class=\"volume\">18<\/span>:<span class=\"fpage\">637<\/span>.<a class=\"ref-link\" href=\"http:\/\/dx.doi.org\/10.1186\/s12879-018-3548-0\" target=\"_blank\" rel=\"noopener\">CrossRef<\/a><a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar_lookup?title=The+role+of+pneumonia+and+secondary+bacterial+infection+in+fatal+and+serious+outcomes+of+pandemic+influenza+a(H1N1)pdm09&amp;author=MacIntyre+CR&amp;author=Chughtai+AA&amp;author=Barnes+M&amp;publication+year=2018&amp;journal=BMC+Infect+Dis&amp;volume=18&amp;doi=10.1186%2Fs12879-018-3548-0\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><a class=\"ref-link\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30526505\" target=\"_blank\" rel=\"noopener\">PubMed<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref5\" class=\"circle-list__item\" aria-flowto=\"reference-5-content reference-5-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">5<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-5-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">Zheng<\/span>,\u00a0<span class=\"given-names\">Z<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Chen<\/span>,\u00a0<span class=\"given-names\">R<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Li<\/span>,\u00a0<span class=\"given-names\">Y<\/span><\/span>,\u00a0<span class=\"etal\">et al.<\/span><span class=\"article-title\">The clinical characteristics of secondary infection of lower respiratory in severe acute respiratory syndrome<\/span>.\u00a0<span class=\"source\">Chin J Respir Crit Care Med<\/span>\u00a0<span class=\"year\">2003<\/span>;<span class=\"volume\">2<\/span>:<span class=\"fpage\">270<\/span>\u2013<span class=\"lpage\">274<\/span>.<a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar_lookup?title=The+clinical+characteristics+of+secondary+infection+of+lower+respiratory+in+severe+acute+respiratory+syndrome&amp;author=Zheng+Z&amp;author=Chen+R&amp;author=Li+Y&amp;publication+year=2003&amp;journal=Chin+J+Respir+Crit+Care+Med&amp;volume=2&amp;pages=270-274\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref6\" class=\"circle-list__item\" aria-flowto=\"reference-6-content reference-6-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">6<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-6-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">Rijnders<\/span>,\u00a0<span class=\"given-names\">B<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Schauwvlieghe<\/span>,\u00a0<span class=\"given-names\">A<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Wauters<\/span>,\u00a0<span class=\"given-names\">J<\/span><\/span>. Influenza-associated pulmonary aspergillosis: a local or global lethal combination?\u00a0<em class=\"italic\">Clin Infect Dis<\/em>\u00a0<span class=\"year\">2020<\/span>. doi:\u00a0<span class=\"pub-id doi\">2020.10.1093\/cid\/ciaa010<\/span>.<a class=\"ref-link\" href=\"http:\/\/dx.doi.org\/10.1093\/cid\/ciaa010\" target=\"_blank\" rel=\"noopener\">CrossRef<\/a><a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=Rijnders,+B,+Schauwvlieghe,+A,+Wauters,+J.+Influenza-associated+pulmonary+aspergillosis:+a+local+or+global+lethal+combination?+Clin+Infect+Dis2020.+doi:+2020.10.1093\/cid\/ciaa010.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref7\" class=\"circle-list__item\" aria-flowto=\"reference-7-content reference-7-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">7<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-7-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">Huang<\/span>,\u00a0<span class=\"given-names\">C<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Wang<\/span>,\u00a0<span class=\"given-names\">Y<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Li<\/span>,\u00a0<span class=\"given-names\">X<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Ren<\/span>,\u00a0<span class=\"given-names\">L<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Zhao<\/span>,\u00a0<span class=\"given-names\">J<\/span><\/span>,\u00a0<span class=\"etal\">et al.<\/span>\u00a0Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.\u00a0<em class=\"italic\">Lancet<\/em>\u00a0<span class=\"year\">2020<\/span>. doi:\u00a0<span class=\"pub-id doi\">10.1016\/S0140-6736(20)30183-5<\/span>.<a class=\"ref-link\" href=\"http:\/\/dx.doi.org\/10.1016\/S0140-6736(20)30183-5\" target=\"_blank\" rel=\"noopener\">CrossRef<\/a><a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=Huang,+C,+Wang,+Y,+Li,+X,+Ren,+L,+Zhao,+J,+et+al.+Clinical+features+of+patients+infected+with+2019+novel+coronavirus+in+Wuhan,+China.+Lancet2020.+doi:+10.1016\/S0140-6736(20)30183-5.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref8\" class=\"circle-list__item\" aria-flowto=\"reference-8-content reference-8-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">8<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-8-content\" class=\"circle-list__item__grouped__content\"><span class=\"string-name\"><span class=\"surname\">Yang<\/span>,\u00a0<span class=\"given-names\">X<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Yu<\/span>,\u00a0<span class=\"given-names\">Y<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Xu<\/span>,\u00a0<span class=\"given-names\">J<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Shu<\/span>,\u00a0<span class=\"given-names\">H<\/span><\/span>,\u00a0<span class=\"string-name\"><span class=\"surname\">Xia<\/span>,\u00a0<span class=\"given-names\">J<\/span><\/span>,\u00a0<span class=\"etal\">et al.<\/span>\u00a0Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.\u00a0<em class=\"italic\">Lancet Respir Med<\/em>\u00a0<span class=\"year\">2020<\/span>. doi:\u00a0<span class=\"pub-id doi\">10.1016\/S2213-2600(20)30079-5<\/span>.<a class=\"ref-link\" href=\"http:\/\/dx.doi.org\/10.1016\/S2213-2600(20)30079-5\" target=\"_blank\" rel=\"noopener\">CrossRef<\/a><a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=Yang,+X,+Yu,+Y,+Xu,+J,+Shu,+H,+Xia,+J,+et+al.+Clinical+course+and+outcomes+of+critically+ill+patients+with+SARS-CoV-2+pneumonia+in+Wuhan,+China:+a+single-centered,+retrospective,+observational+study.+Lancet+Respir+Med2020.+doi:+10.1016\/S2213-2600(20)30079-5.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref9\" class=\"circle-list__item\" aria-flowto=\"reference-9-content reference-9-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">9<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-9-content\" class=\"circle-list__item__grouped__content\"><span class=\"collab\">Prevention and control program of the novel coronavirus pneumonia<\/span>, sixth edition. National Health Commission of the People\u2019s Republic of China website.\u00a0<a class=\"uri\" href=\"http:\/\/www.nhc.gov.cn\/jkj\/s3577\/202003\/4856d5b0458141fa9f376853224d41d7\/files\/4132bf035bc242478a6eaf157eb0d979.pdf\">http:\/\/www.nhc.gov.cn\/jkj\/s3577\/202003\/4856d5b0458141fa9f376853224d41<br \/>\nd7\/files\/4132bf035bc242478a6eaf157eb0d979.pdf<\/a>. Published 2020. Accessed April 7, 2020.<a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=Prevention+and+control+program+of+the+novel+coronavirus+pneumonia,+sixth+edition.+National+Health+Commission+of+the+People%E2%80%99s+Republic+of+China+website.+http:\/\/www.nhc.gov.cn\/jkj\/s3577\/202003\/4856d5b0458141fa9f376853224d41d7\/files\/4132bf035bc242478a6eaf157eb0d979.pdf.+Published+2020.+Accessed+April+7,+2020.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<div id=\"ref10\" class=\"circle-list__item\" aria-flowto=\"reference-10-content reference-10-button\">\n<div class=\"circle-list__item__indicator\"><\/div>\n<div class=\"circle-list__item__number\" aria-hidden=\"true\" data-test-hidden=\"false\">10<\/div>\n<div class=\"circle-list__item__grouped\">\n<div id=\"reference-10-content\" class=\"circle-list__item__grouped__content\"><span class=\"collab\">Laboratory biological safety guidelines for novel coronavirus<\/span>. National Health Commission of the People\u2019s Republic of China website.\u00a0<a class=\"uri\" href=\"http:\/\/www.nhc.gov.cn\/xcs\/zhengcwj\/202001\/0909555408d842a58828611dde2e6a26.shtml\">http:\/\/www.nhc.gov.cn\/xcs\/zhengcwj\/202001\/0909555408d842a58828611dd<br \/>\ne2e6a26.shtml<\/a>. Published 2020. Accessed April 7, 2020.<a class=\"ref-link\" href=\"https:\/\/scholar.google.com\/scholar?q=Laboratory+biological+safety+guidelines+for+novel+coronavirus.+National+Health+Commission+of+the+People%E2%80%99s+Republic+of+China+website.+http:\/\/www.nhc.gov.cn\/xcs\/zhengcwj\/202001\/0909555408d842a58828611dde2e6a26.shtml.+Published+2020.+Accessed+April+7,+2020.\" target=\"_blank\" rel=\"noopener\">Google Scholar<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>___<br \/>\n<a href=\"https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F\">https:\/\/www.cambridge.org\/core\/journals\/infection-control-and-hospital-epidemiology\/article\/bacterial-and-fungal-infections-in-covid19-patients-a-matter-of-concern\/2835D28A101A8FFAA9A9F4FF8FC4469F<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-94186","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/posts\/94186","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=94186"}],"version-history":[{"count":0,"href":"https:\/\/stateofthenation.co\/index.php?rest_route=\/wp\/v2\/posts\/94186\/revisions"}],"wp:attachment":[{"href":"https:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=94186"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=94186"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateofthenation.co\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=94186"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}