Pulmonary Co-Infections Detected Premortem Underestimate Postmortem Findings in a COVID-19 Autopsy Case Series

Andrew P. Platt; Benjamin T. Bradley; Nadia Nasir; Sydney R. Stein; Sabrina C. Ramelli; Marcos J. Ramos-Benitez; James M. Dickey; Madeleine Purcell; Shreya Singireddy; Nicole Hays; Jocelyn Wu; Katherine Raja; Ryan Curto; Stephen J. Salipante; Claire Chisholm; Stephanie Carnes; Desiree A. Marshall; Brad T. Cookson; Kevin M. Vannella; Ronson J. Madathil; Shahabuddin Soherwardi; Michael T. McCurdy; Kapil K. Saharia; Joseph Rabin; NIH COVID-19 Autopsy Consortium; Alison Grazioli; David E. Kleiner; Stephen M. Hewitt; Joshua A. Lieberman; Daniel S. Chertow

doi:10.3390/pathogens12070932

Pathogens (Jul 2023)

Pulmonary Co-Infections Detected Premortem Underestimate Postmortem Findings in a COVID-19 Autopsy Case Series

Andrew P. Platt,
Benjamin T. Bradley,
Nadia Nasir,
Sydney R. Stein,
Sabrina C. Ramelli,
Marcos J. Ramos-Benitez,
James M. Dickey,
Madeleine Purcell,
Shreya Singireddy,
Nicole Hays,
Jocelyn Wu,
Katherine Raja,
Ryan Curto,
Stephen J. Salipante,
Claire Chisholm,
Stephanie Carnes,
Desiree A. Marshall,
Brad T. Cookson,
Kevin M. Vannella,
Ronson J. Madathil,
Shahabuddin Soherwardi,
Michael T. McCurdy,
Kapil K. Saharia,
Joseph Rabin,
NIH COVID-19 Autopsy Consortium,
Alison Grazioli,
David E. Kleiner,
Stephen M. Hewitt,
Joshua A. Lieberman,
Daniel S. Chertow

Affiliations

Andrew P. Platt: Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
Benjamin T. Bradley: Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
Nadia Nasir: Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
Sydney R. Stein: Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
Sabrina C. Ramelli: Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
Marcos J. Ramos-Benitez: Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
James M. Dickey: Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
Madeleine Purcell: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Shreya Singireddy: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Nicole Hays: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Jocelyn Wu: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Katherine Raja: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Ryan Curto: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Stephen J. Salipante: Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
Claire Chisholm: Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
Stephanie Carnes: American Esoteric Laboratories, Memphis, TN 38134, USA
Desiree A. Marshall: Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
Brad T. Cookson: Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
Kevin M. Vannella: Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
Ronson J. Madathil: Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Shahabuddin Soherwardi: Hospitalist Department, TidalHealth Peninsula Regional, Salisbury, MD 21801, USA
Michael T. McCurdy: University of Maryland School of Medicine, Baltimore, MD 21201, USA
Kapil K. Saharia: Institute of Human Virology, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Joseph Rabin: R Adams Cowley Shock Trauma Center, Department of Surgery and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA
NIH COVID-19 Autopsy Consortium
Alison Grazioli: R Adams Cowley Shock Trauma Center, Department of Medicine and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA
David E. Kleiner: Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
Stephen M. Hewitt: Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
Joshua A. Lieberman: Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
Daniel S. Chertow: Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA

DOI: https://doi.org/10.3390/pathogens12070932
Journal volume & issue: Vol. 12, no. 7
p. 932

Abstract

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Bacterial and fungal co-infections are reported complications of coronavirus disease 2019 (COVID-19) in critically ill patients but may go unrecognized premortem due to diagnostic limitations. We compared the premortem with the postmortem detection of pulmonary co-infections in 55 fatal COVID-19 cases from March 2020 to March 2021. The concordance in the premortem versus the postmortem diagnoses and the pathogen identification were evaluated. Premortem pulmonary co-infections were extracted from medical charts while applying standard diagnostic definitions. Postmortem co-infection was defined by compatible lung histopathology with or without the detection of an organism in tissue by bacterial or fungal staining, or polymerase chain reaction (PCR) with broad-range bacterial and fungal primers. Pulmonary co-infection was detected premortem in significantly fewer cases (15/55, 27%) than were detected postmortem (36/55, 65%; p Pseudomonas, Enterobacterales, and Staphylococcus aureus were the most frequently identified bacteria both premortem and postmortem. Invasive pulmonary fungal infection was detected in five cases postmortem, but in no cases premortem. According to the univariate analyses, the patients with undiagnosed pulmonary co-infection had significantly shorter hospital (p = 0.0012) and intensive care unit (p = 0.0006) stays and significantly fewer extra-pulmonary infections (p = 0.0021). Bacterial and fungal pulmonary co-infection are under-recognized complications in critically ill patients with COVID-19.

Published in Pathogens

ISSN: 2076-0817 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/pathogens

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