{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T16:03:15Z","timestamp":1783612995953,"version":"3.55.0"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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 study examined co-infections and superinfections in critically ill COVID-19 patients admitted to the ICU of a tertiary hospital in Ecuador.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted from February to August 2021, including patients with a confirmed SARS-CoV-2 infection. Demographic data, clinical characteristics, and microbiological findings were analyzed to evaluate the presence of coinfections and superinfections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 24 patients were included, of whom 70.83% (17\/24) 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). The most frequently isolated pathogens were\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      ,\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      , and\n                      <jats:italic>Enterococcus faecalis<\/jats:italic>\n                      . Molecular testing revealed Streptococcus pneumoniae was 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; 62% (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                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f24) and descriptive statistical design.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1664521","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:33:54Z","timestamp":1764830034000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Coinfections and superinfections in critically ill COVID-19 patients in Ecuador: a cross-sectional study of bacterial and viral pathogens"],"prefix":"10.3389","volume":"13","author":[{"given":"Diana","family":"Morales-Jad\u00e1n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Muslin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Viteri-D\u00e1vila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Luis","family":"V\u00e9lez-P\u00e1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estefan\u00eda Belen","family":"Irigoyen-Mogro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos C.","family":"Kyriakidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Angel","family":"Garcia-Bereguiain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismar A.","family":"Rivera-Olivero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"E304","DOI":"10.15167\/2421-4248\/jpmh2020.61.3.1530","article-title":"Determine the most common clinical symptoms in COVID-19 patients: A systematic review and meta-analysis","volume":"61","author":"Alimohamadi","year":"2020","journal-title":"J Prev Med Hyg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1056\/nejmoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J 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