Impact of Fungal and Bacterial Co-infections and Other Factors on Covid-19 Mortality Status at Kenyatta National Hospital Using Binary Logistic Regression Model

Abstract

Background. Coronavirus 2019 (COVID-19) posed significant challenges to global health, with Kenya facing substantial challenges in managing cases and fatalities. Fungal and bacterial coinfections surfaced as critical factors influencing the severity and mortality of COVID-19 patients hence the need for comprehensive research to expound on the association between co-occurring infections and COVID-19 outcomes, particularly in resource constrained settings. Objective. To assess the impact of co-infections, particularly fungal and bacterial, alongside other factors, on the mortality status of COVID-19 patients. Methodology. This is a retrospective cross-sectional analysis of data collected from March 2020 to March 2023. Ethical approval was obtained from the University’s Ethics and Research Committee after which files for adult patients were accessed. Data were collected on demographics, clinical characteristics, and co-infection status for 500 patients selected through purposive sampling. Descriptive statistics and inferential statistics were performed using R version 4.3.2 while, Binary logistic regression was used to determine the impact of co-infections among other factors on mortality status of patients with COVID-19. Results. The study included 500 patients, with 50.2% having fungal co-infections, 80.8% having bacterial co-infections, and 31% having both co-infections. Mortality was significantly higher among patients with co-infections (41.8% for fungal, 30.6% for bacterial, and 23.5% for both). Patients with Aspergillosis, Candida albicans, and Cryptococcus infections were 70%, 60%, and 74% less likely to die from COVID-19, respectively, compared to those without fungal infections. Advanced age (65+ years) increased the likelihood of death by 2.33%, while having comorbidities raised the mortality risk to 102.67%. Patients with prolonged hospital stays had a 2.51% decreased risk of death. Lower SpO2 levels (average 85% in deceased) and the requirement for mechanical ventilation (60% mortality) were significant predictors of mortality. Additionally, patients who needed ventilation were 56% more likely to die from COVID-19. Co-infections with Candida albicans (23.1% mortality) and Staphylococcus aureus (30.8% mortality) were particularly associated with poor outcomes. Conclusion. Fungal co-infections have an exponential effect on the mortality of COVID-19 patients at Kenyatta National Hospital. Early detection and management of the co-infections are crucial to improving patient outcomes. The study highlights the need for targeted diagnostic protocols and treatment strategies in resource-constrained settings. Further research is recommended to explore preventive measures and the efficacy of specific treatments for coinfections in COVID-19 patients.