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The Urgency of COVID-19 Vaccination: A Systematic Review of the Clinical Outcomes of COVID-19-Staphylococcus Aureus Co-Infection

Jenna Adalbert, BS(1) & Karan Varshney, MPH(2)

Sidney Kimmel Medical College at Thomas Jefferson University(1)

Deakin University School of Medicine(2)

Introduction: Endemic to the hospital environment, Staphylococcus aureus is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with Staphylococcus aureus remains unclear.   

Objectives: To systematically review the literature in order to describe the clinical outcomes of COVID-19-Staphylococcus aureus co-infection.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searches were conducted in PubMed, Scopus, Ovid MEDLINE, CINAHL, ScienceDirect, medRxiv, and the WHO COVID-19 database. Original research articles that were in English, included patients infected with both COVID-19 and Staphylococcus aureus, and provided a description of clinical outcomes for patients were eligible. For the final articles that were selected, the following data was extracted: type of staphylococcal species, onset of co-infection, patient sex, age, symptoms, hospital interventions, and clinical outcomes.

Results: Searches generated a total of 779 articles, and of those, a total of 26 studies were eligible for this review. In total, there were 68 co-infected patients. In addition to COVID-19 infection, 63.8% of patients were infected with methicillin-sensitive Staphylococcus aureus (MSSA), and 36.2% were infected with methicillin-resistant Staphylococcus aureus (MRSA); a single patient was infected with both strains of Staphylococcus aureus. Hospital-acquired MSSA or MRSA (HA-MSSA or HA-MRSA) infection was diagnosed in 60.3% of patients. 57.4% of patients were male, and mean patient age was 60.4 years (SD = 15.7). Fever, cough, and shortness of breath were the most frequently reported symptoms. Aside from antibiotics, the most common hospital interventions were corticosteroids (25.7%) and intubation with mechanical ventilation (61.8%). There were a total of 43 deaths (63.2%) reported.

Conclusions: Co-infection of COVID-19 and Staphylococcus aureus has been shown to considerably increase the risk of patient mortality during hospital admission. Unfortunately, the most common treatments for COVID-19 in our study are significant risk factors for bacterial infection. Our findings emphasize the urgency of COVID-19 vaccination in order to prevent hospitalization for COVID-19 treatment and the subsequent susceptibility to hospital-acquired Staphylococcus aureus co-infection.