Coinfections and Superinfections in Critically Ill COVID-19 Patients in Ecuador: A Cross-Sectional Study of Bacterial and Viral Pathogens

Diana Morales-Jadán¹Claire Muslin¹Carolina Viteri-Dávila¹Jorge Luis Vélez-Páez^2,3Estefanía Belen Irigoyen-Mogro³Nikolaos C. Kyriakidis¹Miguel Angel Garcia-Beregueain¹Ismar Alejandra Rivera-Olivero^4*

• ¹One Health Research Group. Universidad de Las Américas, Quito, Ecuador
• ²Universidad Central de Ecuador Facultad de Ciencias Medicas, Quito, Ecuador
• ³Hospital Pablo Arturo Suarez, Unidad de Terapia Intensiva, Centro de Investigación Clínica, Quito, Ecuador
• ⁴One Health Research Group. Facultad de Medicina. Universidad de Las Américas., Quito, Ecuador

The COVID-19 pandemic has deeply affected Latin America and Ecuador. Coinfections and superinfections increase the risk of morbidity and mortality in COVID-19 patients. This cross-sectional study examined co-infections and superinfections in critically ill COVID-19 patients admitted to the ICU of a tertiary hospital in Ecuador from February to August 2021. This study included patients with a confirmed SARS-CoV-2 infection and analyzed their demographic data, clinical characteristics, and microbiological findings. The results showed that 70.83% (17/24) of patients experienced either coinfection or superinfection. Community-acquired coinfections were identified in 12.5% (3/24) of patients, whereas hospital-acquired superinfections were detected in 58.3% (14/24) of patients. The most frequently isolated pathogens were Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. Molecular testing revealed Streptococcus pneumoniae as the most prevalent organism. Bloodstream infections were the most common superinfections, with an attack rate of 92.8% (13/14). The median time from hospital admission to superinfection diagnosis was 5 days. The study also found that 33% (8/24) of patients died, all of whom were men. Sixty-two percent (5/8) of the patients who died have superinfection. However, infections were not identified as independent predictors of death, given the small cohort size (n=24) and the descriptive statistical design. These findings underscore the importance of robust monitoring of co-infections and superinfections in critically ill COVID-19 patients, especially in resource-limited settings. The high prevalence of these infections highlights the need for continued investment in microbiological surveillance, rapid diagnostics, and antimicrobial stewardship programs to mitigate long-term consequences and address the increasing threat of antimicrobial resistance.