The Effect on Mortality of Bacterial Co-Infections on Critically Ill Patients with Community-Acquired COVID-19 and Influenza Pneumonia: A Systematic Review.

Publication date: Jun 16, 2025

Background: Bacterial co-infections in patients with viral pneumonia might increase mortality. In this study we aimed to evaluate their effect on the mortality of critically ill patients with viral pneumonia. Methods: A systematic search was conducted in PubMed, Web of Science, Scopus and Cochrane from inception until 30 March 2025. We included studies comparing the effect on mortality of bacterial co-infections in critically ill patients with viral pneumonia. The risk of bias was assessed by the Newcastle-Ottawa Scale. Results: From 3643 studies, 10 were included in our study with a total of 2862 COVID-19 patients and 4573 influenza patients. Seven studies were retrospective and three prospective. In total, 359/2862 of the COVID-19 and 904/4573 of the influenza patients were co-infected. Co-infections increased mortality in five out of the six studies evaluating COVID-19 patients and in two out of the eight studies evaluating influenza patients. Conclusions: The majority of the included studies were retrospective, which may limit the accuracy of these results. The exclusion of non-English literature may have led to the omission of relevant data. Based on our results, the impact of bacterial co-infection may be more pronounced in patients with COVID-19 pneumonia admitted to the ICU than in patients with influenza pneumonia.

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Concepts Keywords
Covid Bacterial Infections
Increase co-infection
Ottawa Coinfection
Pneumonia Community-Acquired Infections
COVID-19
critical care
Critical Illness
Humans
Influenza, Human
mortality
pneumonia
Pneumonia, Viral
Retrospective Studies
SARS-CoV-2
virus

Semantics

Type Source Name
disease MESH Co-Infections
disease MESH Critically Ill
disease MESH COVID-19
disease MESH Influenza
disease MESH Pneumonia
disease MESH viral pneumonia
disease MESH Infections
drug DRUGBANK Coenzyme M
drug DRUGBANK Indoleacetic acid
disease MESH death
disease MESH Acute Respiratory Distress Syndrome
disease MESH Respiratory failure
disease MESH syndrome
disease MESH hyaline membrane disease
disease MESH Virus Diseases
disease MESH superinfection
disease MESH severe acute respiratory syndrome
disease MESH middle east respiratory syndrome
disease IDO process
disease IDO pathogen
disease MESH etiology
disease MESH Bacterial Infections
disease MESH Community-Acquired Infections

Original Article

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