Are Mycoplasma pneumoniae coinfections frequent in COVID-19 patients? A systematic review

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Fuente: Libonatti et al.<a class="elsevierStyleCrossRef" href="#bib0150">13</a>." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Fernanda Vega, Carina Libonatti, Ornela Y. Ramos, Marina Basualdo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "María Fernanda" "apellidos" => "Vega" ] 1 => array:2 [ "nombre" => "Carina" "apellidos" => "Libonatti" ] 2 => array:2 [ "nombre" => "Ornela Y." "apellidos" => "Ramos" ] 3 => array:2 [ "nombre" => "Marina" "apellidos" => "Basualdo" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Bifidobacterium choladohabitans integra la microbiota intestinal de A. mellifera.</li><li class="elsevierStyleListItem" id="lsti0010">•E. faecium compone la microbiota del pan de abejas en colonias de A. mellifera.</li><li class="elsevierStyleListItem" id="lsti0015">•E. faecium integra el núcleo bacteriano estable de las colonias de abejas melíferas.</li><li class="elsevierStyleListItem" id="lsti0020">•No hay antagonismo cruzado entre bacterias aisladas de intestino y pan de abejas.</li></ul>" ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754124000245?idApp=UINPBA00004N" "url" => "/03257541/0000005600000003/v1_202409170456/S0325754124000245/v1_202409170456/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0325754124000786" "issn" => "03257541" "doi" => "10.1016/j.ram.2023.07.007" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "599" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2024;56:249-57" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Detección de microorganismos y genes de resistencia en hemocultivos positivos mediante FilmArray® panel BCID2: experiencia en un hospital pediátrico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "249" "paginaFinal" => "257" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Detection of microorganisms and resistance genes from positive blood cultures using the FilmArray® BCID2 panel: Experience in a pediatric hospital" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marilina Kuzawka, Martín Cassanelli, Fabrina Capecce, Rosana Pereda" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marilina" "apellidos" => "Kuzawka" ] 1 => array:2 [ "nombre" => "Martín" "apellidos" => "Cassanelli" ] 2 => array:2 [ "nombre" => "Fabrina" "apellidos" => "Capecce" ] 3 => array:2 [ "nombre" => "Rosana" "apellidos" => "Pereda" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•BCID2 detectó más microorganismos que el cultivo en bacteriemias polimicrobianas.</li><li class="elsevierStyleListItem" id="lsti0010">•En la detección de resistencia la concordancia fue buena con algunas excepciones.</li><li class="elsevierStyleListItem" id="lsti0015">•BCID2 disminuyó significativamente el tiempo de informe con respecto al cultivo.</li></ul>" ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754124000786?idApp=UINPBA00004N" "url" => "/03257541/0000005600000003/v1_202409170456/S0325754124000786/v1_202409170456/es/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Are Mycoplasma pneumoniae coinfections frequent in COVID-19 patients? A systematic review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "258" "paginaFinal" => "264" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jessica Mosmann, María Celia Frutos, Javier Anibal Origlia, María Lucia Gallo Vaulet, Miriam Gabriela García, Gabriela Vilar, Celeste Pérez, María Julia Madariaga, Cecilia Cuffini, María Estela Cadario" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Jessica" "apellidos" => "Mosmann" "email" => array:1 [ 0 => "jessica.mosmann@unc.edu.ar" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Celia" "apellidos" => "Frutos" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] 2 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "Javier Anibal" "apellidos" => "Origlia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "María Lucia" "apellidos" => "Gallo Vaulet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Miriam Gabriela" "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Gabriela" "apellidos" => "Vilar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "Celeste" "apellidos" => "Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 7 => array:3 [ "nombre" => "María Julia" "apellidos" => "Madariaga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 8 => array:3 [ "nombre" => "Cecilia" "apellidos" => "Cuffini" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] 2 => array:2 [ "etiqueta" => "2" "identificador" => "fn0010" ] ] ] 9 => array:3 [ "nombre" => "María Estela" "apellidos" => "Cadario" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] 2 => array:2 [ "etiqueta" => "2" "identificador" => "fn0010" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Instituto de Virología, Dr. J.M. Vanella, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cátedra de Patología de Aves y Pilíferos, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Laboratorio de Virología y Biología Molecular, Hospital Interzonal General Agudos Pedro Fiorito, Buenos Aires, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Bacteriología, INEI-ANLIS Dr. Carlos G Malbrán, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Departamento de Virología, INEI-ANLIS Dr. Carlos G Malbrán, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Sección Serología y Pruebas Biológicas, Instituto de Zoonosis Luis Pasteur, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Son frecuentes las coinfecciones con Mycoplasma pneumoniae en pacientes con COVID-19? Una revisión sistemática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1942 "Ancho" => 2471 "Tamanyo" => 236472 ] ] "descripcion" => array:1 [ "en" => "PRISMA flow-chart." ] ] ] "textoCompleto" => "IntroductionMycoplasma pneumoniae (M.pneumoniae) commonly causes infections of the respiratory system among all age groups<a class="elsevierStyleCrossRef" href="#bib0445">42</a>. This microorganism is one of the leading causes of community-acquired pneumonia (CAP), especially in children. Most pneumonia cases are benign, whereas some of them may develop into severe pneumonia and refractory pneumonia with pleural effusion, multi-organ dysfunction, and serious long-term sequelae, including bronchiolitis obliterans and bronchiectasis<a class="elsevierStyleCrossRef" href="#bib0315">16</a>. Airborne droplets containing M. pneumoniae can be transmitted and spread among people through coughing and sneezing. In most cases, clinical symptoms are non-specific and cough is the main symptom, which is usually paroxysmal and often persistent<a class="elsevierStyleCrossRef" href="#bib0450">43</a>. Coinfection of M. pneumoniae has been identified in viral pneumonia<a class="elsevierStyleCrossRef" href="#bib0435">40</a>. At present, coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 virus has spread to almost every part of the world. The combination of SARS-CoV-2 infection and other respiratory pathogens is a challenge for health care systems in terms of diagnosis, treatment, and management. Although viral infection and bacterial infection are essentially different in terms of pathogenesis, the clinical manifestations of COVID-19 and CAP, such as fever, dry cough, fatigue, all-over ache and chest tightness<a class="elsevierStyleCrossRef" href="#bib0465">46</a>, are similar. Clinical practice indicates that reactive lymphocytes are frequently observed in COVID-19 infection, while in M. pneumoniae infection cold agglutination is common<a class="elsevierStyleCrossRef" href="#bib0335">20</a>. There are only subtle differences in radiographic features between these two infections<a class="elsevierStyleCrossRef" href="#bib0320">17</a>.Several studies have reported a wide range of coinfection rates in SARS-CoV-2 patients, with rates ranging from 3% to more than 20% being reported<a class="elsevierStyleCrossRef" href="#bib0355">24</a>. Therefore, studies that identify the pathogens coinfecting COVID-19 patients and the evaluation of their impact on the clinical outcome are crucial. These data may guide clinicians to establish a directed antimicrobial therapy, decrease the irrational use of antibiotics and improve the clinical outcome.The objective was to assess the molecular prevalence of coinfection with this atypical bacterium in COVID-19 patients and describe the clinical features, laboratory parameters, complications, clinical outcomes of such coinfections, to determine the importance of detecting M. pneumoniae in patients with COVID 19 and establishing an adequate treatment.Materials and methodsA systematic review of the literature was performed focusing on the identification of M. pneumoniae coinfections in SARS-CoV-2 patients. PubMed was searched using a combination of key terms such as COVID-19 and M. pneumoniae, SARS-COV-2 and M. pneumoniae, bacterial coinfections and COVID-19, pneumonia and SARS-COV-2, pneumonia and COVID-19. We also used the same terms in Spanish and included articles written in English and Spanish (the primary languages of the investigators). We also reviewed the reference lists for the articles identified by our search, as well as those of any included studies. We only included those studies using molecular methods for M. pneumoniae detection and excluded all studies employing culture or serology techniques for M. pneumoniae identification.Data abstractionEach abstract and the articles selected for full review were evaluated by all investigators. For each included article, the study characteristics and data regarding detection were abstracted by the authors. For detection data, defined cases were included and possible cases were excluded. For each report, the type of surveillance used, number of cases reported and total population studies were documented. This review was conducted and reported according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow-charts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Results and discussionThe literature search yielded 103 studies. After a first screening, 64 were excluded because they were not related to the subject and 4 were duplicate. After full text reading, 14 studies were included (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Specifically, four of the studies were retrospective and ten were prospective. Most studies were from the USA, Brazil, China and France and the remaining ones from the United Kingdom, Spain, India, Turkey, Peru and Iran. A total of 5855 COVID-19 patients were identified and included in our review (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Concerns regarding coinfections during viral pandemics, specifically coinfections with respiratory bacterial pathogens, are borne from the experience in H1N1 influenza A, Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS)<a class="elsevierStyleCrossRefs" href="#bib0240">1,22,33</a>. In these outbreaks, as in the COVID-19 pandemic, much lower coinfection rates with M. pneumoniae were reported<a class="elsevierStyleCrossRefs" href="#bib0260">5,11,36,39,45</a>. The prevalence of reported M. pneumoniae infections in COVID-19 patients ranged from 0–33.3% in the retrospective studies and 0–28.1% in the prospective studies. These differences in the proportion of coinfection may be attributable to the selection of case-patients (adults or children), geographic factors, season and the clinical condition<a class="elsevierStyleCrossRefs" href="#bib0280">9,10,25,27</a>. High prevalence of coinfection between M. pneumoniae and SARS CoV-2 was described using serological methods<a class="elsevierStyleCrossRefs" href="#bib0325">18,28,47</a>. However, these methods are not highly specific tests and may result in an overestimation of infections<a class="elsevierStyleCrossRef" href="#bib0420">37</a>. In general, the bacterium less frequently found in coinfection with SARS-COV-2 is M. pneumoniae<a class="elsevierStyleCrossRefs" href="#bib0300">13,15,16</a>. Many of the most recent studies showed that coinfections appeared to be relatively rare. However, due to the variability between countries and the limited country/region representation in the few studies published, the results shown cannot be extrapolated to Latin America. That is why it is important to generate local evidence to support decision-making. In Argentina, only one multicenter study reported the presence of M. pneumoniae in 12.3% (24/187) of COVID-19 patients, using nested-PCR<a class="elsevierStyleCrossRef" href="#bib0305">14</a>.In two studies (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), most patients who had contracted a bacterial respiratory infection did not test positive for COVID-19<a class="elsevierStyleCrossRefs" href="#bib0250">3,4,24</a>. The median age of COVID-19 patients studied for M. pneumoniae was 48 years old (range 1–107), most of whom were male<a class="elsevierStyleCrossRefs" href="#bib0245">2,5,8,21,23,30,34,38</a>. This observation is not consistent with the established literature that indicates that community-acquired viral coinfections are more common in younger populations<a class="elsevierStyleCrossRef" href="#bib0410">35</a>.The most common clinical symptoms in COVID-19 coinfected patients were fever, cough and dyspnea<a class="elsevierStyleCrossRefs" href="#bib0260">5,6,12,21,23,30,38</a>. However, these symptoms are similar among COVID-19 monoinfections and coinfections with other pathogens, which made the clinical differentiation difficult. Thus, laboratory confirmation is required.The clinical presentations of M. pneumoniae range from mild infections affecting the upper respiratory tract to pneumonia that needs hospital admission<a class="elsevierStyleCrossRef" href="#bib0450">43</a>. It has been proposed that pathogens such as M. pneumoniae can exacerbate clinical symptoms, increase morbidity and prolong the stay in the intensive care unit (ICU) in COVID-19 patients<a class="elsevierStyleCrossRefs" href="#bib0260">5,13,23,30,34</a>. Boschiero et al., 2022<a class="elsevierStyleCrossRef" href="#bib0250">3</a> did not find an association between coinfections and more severe COVID-19-related outcomes in Brazil, while Perez-Lazo et al., 2021<a class="elsevierStyleCrossRef" href="#bib0385">30</a> reported a high rate of mortality in Peru (18.1%). The authors described an elevated development of sepsis in the group with M. pneumoniae coinfections (37.4%); however, they found that mortality was similar among coinfected and monoinfected groups<a class="elsevierStyleCrossRef" href="#bib0385">30</a>. In two studies included in this review a lower mortality rate was found<a class="elsevierStyleCrossRefs" href="#bib0295">12,23</a>, whereas the remaining studies did not report any mortality rates<a class="elsevierStyleCrossRefs" href="#bib0245">2,3,5,21,34,38</a>. Lower rates of comorbidities, such as hypertension, diabetes mellitus, renal disease and obesity<a class="elsevierStyleCrossRefs" href="#bib0260">5,30</a> were described in coinfected patients.Antibiotic use was reported in five studies<a class="elsevierStyleCrossRefs" href="#bib0260">5,12,23,30,41</a>, with >50% of patients receiving empirical antibiotics<a class="elsevierStyleCrossRef" href="#bib0385">30</a>. This is particularly important in Latin America, where the abuse of antibiotics in COVID-19 patients has reached alarming levels<a class="elsevierStyleCrossRefs" href="#bib0270">7,32</a>. The finding that there was a low number of patients with bacterial infections, such as M. pneumoniae, Klebsiella pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, highlights the fact that the empirical use of antibiotics in patients with COVID-19 should not be recommended<a class="elsevierStyleCrossRefs" href="#bib0365">26,29,31,44</a>. The COVID-19 pandemic exacerbated the known challenges to optimal antibiotic administration, representing a direct threat to patient safety and public health through antibiotic overprescription and promotion of bacterial resistance.Unfortunately, there were no specific data on clinical information and therapeutic interventions. Due to the diversity of studies and the low number of patients with detected coinfection with M. pneumoniae, it was difficult to find symptoms indicating coinfection with M. pneumoniae and SARS-CoV-2 in the studies included in our review.Despite the fact that M. pneumoniae coinfections were searched and infrequently documented in patients with COVID-19 pneumonia, routine testing for respiratory pathogens should be advised, since agents for which specific therapy can be prescribed may be detected and may have a beneficial impact on patient outcomes.Ethical approvalNot required.FundingNone.Conflict of interestsThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2244600" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1877160" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2244601" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1877159" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data abstraction" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results and discussion" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical approval" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-30" "fechaAceptado" => "2024-05-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1877160" "palabras" => array:4 [ 0 => "SARS-CoV-2 infection" 1 => "COVID-19" 2 => "Mycoplasma pneumoniae" 3 => "Coinfection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1877159" "palabras" => array:4 [ 0 => "Infección por SARS-CoV-2" 1 => "COVID-19" 2 => "Mycoplasma pneumoniae" 3 => "Coinfección" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Understanding the proportion of SARS-CoV-2 patients with Mycoplasmapneumoniae coinfection is crucial for treating patients suffering from coronavirus disease (COVID-19), help to ensure responsible use of antibiotics and minimize the negative consequences of overuse. In addition, this knowledge could have an impact on empirical antibiotic management guidelines for patients with COVID-19. This systematic review aimed to identify the prevalence of M. pneumoniae in patients with coronavirus disease 2019 (COVID-19).A bibliographic search of studies published in Spanish or English was conducted using the PubMed search engine. Fourteen articles from different continents (America, Asia and Europe) were included, involving a total of 5855 patients in these studies. The mean age of COVID-19 patients with M. pneumoniae was 48 years old (range 1–107), most of whom were male. The detection of laboratory-confirmed M. pneumoniae infection varied between 0 and 33.3%. Most of patients referred fever, cough, and dyspnea, and received empirical antibiotic treatment. Bacterial coinfection was not associated with increased ICU admission and mortality. The prevalence of coinfection showed extremely dissimilar figures according to the population studied and diagnostic criteria. However, it is important to develop Latin American studies, given the heterogeneity observed in the studies conducted in different countries. Standardized definitions should be developed in order to be able to assess the impact of coinfections in patients with a diagnosis of COVID-19." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Comprender la proporción de coinfección por coronavirus (COVID-19) y Mycoplasma pneumoniae es crucial para tratar a los pacientes con COVID-19, garantizando el empleo responsable de antibióticos y minimizando las consecuencias negativas del uso excesivo. Además, este conocimiento podría tener un impacto en las pautas de manejo empírico de antibióticos en pacientes con COVID-19. Esta revisión sistemática tuvo como objetivo identificar la prevalencia de M. pneumoniae en pacientes con COVID-19. Para ello se realizó una búsqueda bibliográfica de estudios publicados en español o inglés utilizando el buscador PubMed. Se incluyeron 14 artículos de diferentes continentes (América, Asia y Europa), con un total de 5855 pacientes estudiados. La media de edad de los pacientes COVID-19 con M. pneumoniae fue de 48 años (intervalo: 1 a 107 años) y la mayoría de ellos fueron varones. La detección de M. pneumoniae confirmada por laboratorio en pacientes con COVID-19 varió del 0 al 33,3%. La mayoría de los pacientes refirieron fiebre, tos y disnea, y recibieron antibióticos empíricos. La coinfección bacteriana no se asoció con un aumento de la admisión en UCI ni de la mortalidad. La prevalencia de coinfección fue muy disímil según la población estudiada y los criterios diagnósticos empleados. Dada la heterogeneidad de resultados en los diferentes países, es importante desarrollar estudios en América Latina, como así también establecer definiciones estandarizadas para poder evaluar el impacto real de las coinfecciones en pacientes con COVID-19." ] ] "NotaPie" => array:3 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Grupo de Trabajo Bacterias Atípicas, Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas (SADEBAC), División de la Asociación Argentina de Microbiología." ] 1 => array:3 [ "etiqueta" => "1" "nota" => "These first authors contributed equally to this work." "identificador" => "fn0005" ] 2 => array:3 [ "etiqueta" => "2" "nota" => "These authors contributed equally to this work." "identificador" => "fn0010" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1942 "Ancho" => 2471 "Tamanyo" => 236472 ] ] "descripcion" => array:1 [ "en" => "PRISMA flow-chart." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of study \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overall rate of coinfection (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M. pneumomiae/SARS-CoV-2 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic methods \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcomes of COVID19/M. pneumoniae patients (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blasco et al., 2020<a class="elsevierStyleCrossRef" href="#bib0245">2</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/103 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/3 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiplex PCR assay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Boschiero et al., 2022<a class="elsevierStyleCrossRef" href="#bib0250">3</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84/1503 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/84 (2.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (respiratory pathogen panel) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chaudry et al., 2022<a class="elsevierStyleCrossRef" href="#bib0260">5</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17/194 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/17 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (CARDS toxin gene) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin, or fluoroquinolones, or doxycycline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chi et al., 2020<a class="elsevierStyleCrossRef" href="#bib0265">6</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/17 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/0 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiplex PCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contou et al., 2020<a class="elsevierStyleCrossRef" href="#bib0275">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">France \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26/92 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/26 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (respiratory pathogen panel) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Easom et al., 2020<a class="elsevierStyleCrossRef" href="#bib0295">12</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29/67 (43.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/67 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiplex PCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doxycycline and monofloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hazra et al., 2020<a class="elsevierStyleCrossRef" href="#bib0330">19</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/459 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/459 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (respiratory pathogen panel) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Husain et al., 2022<a class="elsevierStyleCrossRef" href="#bib0340">21</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">France \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22/784 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/22 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiplex PCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Karaaslan et al., 2021<a class="elsevierStyleCrossRef" href="#bib0350">23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Turkey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7/93 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/93 (1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kim et al., 2020<a class="elsevierStyleCrossRef" href="#bib0355">24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23/115 (20.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/116 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (respiratory pathogen panel) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pérez-Lazo et al., 2021<a class="elsevierStyleCrossRef" href="#bib0385">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peru \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">154/295 (52.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83/295 (28.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (18.1) died \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Richardson et al. 2020<a class="elsevierStyleCrossRef" href="#bib0405">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42/1996 (2.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/42 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (respiratory pathogen panel) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Soltani et al., 2021<a class="elsevierStyleCrossRef" href="#bib0425">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iran \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/40 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9/40 (22.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCR (P1 adhesion gene) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Varela et al., 2022<a class="elsevierStyleCrossRef" href="#bib0440">41</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31/97 (31.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/31 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR (respiratory pathogen panel) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3657417.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Years (mean). 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Special article

¿Son frecuentes las coinfecciones con Mycoplasma pneumoniae en pacientes con COVID-19? Una revisión sistemática

Jessica Mosmanna,1,

Corresponding author

jessica.mosmann@unc.edu.ar

Corresponding author.

, María Celia Frutosa,h,1, Javier Anibal Origliab, María Lucia Gallo Vauletc, Miriam Gabriela Garcíad, Gabriela Vilare, Celeste Péreze, María Julia Madariagag, Cecilia Cuffinia,h,2, María Estela Cadarioe,f,2

a Instituto de Virología, Dr. J.M. Vanella, Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina

b Cátedra de Patología de Aves y Pilíferos, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina

c Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina

d Laboratorio de Virología y Biología Molecular, Hospital Interzonal General Agudos Pedro Fiorito, Buenos Aires, Argentina

e Departamento de Bacteriología, INEI-ANLIS Dr. Carlos G Malbrán, Ciudad Autónoma de Buenos Aires, Argentina

f Departamento de Virología, INEI-ANLIS Dr. Carlos G Malbrán, Ciudad Autónoma de Buenos Aires, Argentina

g Sección Serología y Pruebas Biológicas, Instituto de Zoonosis Luis Pasteur, Ciudad Autónoma de Buenos Aires, Argentina

h Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> &#40;<span class="elsevierStyleItalic">M&#46;</span><span class="elsevierStyleItalic">pneumoniae</span>&#41; commonly causes infections of the respiratory system among all age groups<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">42</span></a>&#46; This microorganism is one of the leading causes of community-acquired pneumonia &#40;CAP&#41;&#44; especially in children&#46; Most pneumonia cases are benign&#44; whereas some of them may develop into severe pneumonia and refractory pneumonia with pleural effusion&#44; multi-organ dysfunction&#44; and serious long-term sequelae&#44; including bronchiolitis obliterans and bronchiectasis<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">16</span></a>&#46; Airborne droplets containing <span class="elsevierStyleItalic">M&#46; pneumoniae</span> can be transmitted and spread among people through coughing and sneezing&#46; In most cases&#44; clinical symptoms are non-specific and cough is the main symptom&#44; which is usually paroxysmal and often persistent<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">43</span></a>&#46; Coinfection of <span class="elsevierStyleItalic">M&#46; pneumoniae</span> has been identified in viral pneumonia<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">40</span></a>&#46; At present&#44; coronavirus disease 2019 &#40;COVID-19&#41; due to SARS-CoV-2 virus has spread to almost every part of the world&#46; The combination of SARS-CoV-2 infection and other respiratory pathogens is a challenge for health care systems in terms of diagnosis&#44; treatment&#44; and management&#46; Although viral infection and bacterial infection are essentially different in terms of pathogenesis&#44; the clinical manifestations of COVID-19 and CAP&#44; such as fever&#44; dry cough&#44; fatigue&#44; all-over ache and chest tightness<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">46</span></a>&#44; are similar&#46; Clinical practice indicates that reactive lymphocytes are frequently observed in COVID-19 infection&#44; while in <span class="elsevierStyleItalic">M&#46; pneumoniae</span> infection cold agglutination is common<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">20</span></a>&#46; There are only subtle differences in radiographic features between these two infections<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have reported a wide range of coinfection rates in SARS-CoV-2 patients&#44; with rates ranging from 3&#37; to more than 20&#37; being reported<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">24</span></a>&#46; Therefore&#44; studies that identify the pathogens coinfecting COVID-19 patients and the evaluation of their impact on the clinical outcome are crucial&#46; These data may guide clinicians to establish a directed antimicrobial therapy&#44; decrease the irrational use of antibiotics and improve the clinical outcome&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective was to assess the molecular prevalence of coinfection with this atypical bacterium in COVID-19 patients and describe the clinical features&#44; laboratory parameters&#44; complications&#44; clinical outcomes of such coinfections&#44; to determine the importance of detecting <span class="elsevierStyleItalic">M&#46; pneumoniae</span> in patients with COVID 19 and establishing an adequate treatment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A systematic review of the literature was performed focusing on the identification of <span class="elsevierStyleItalic">M&#46; pneumoniae</span> coinfections in SARS-CoV-2 patients&#46; PubMed was searched using a combination of key terms such as COVID-19 and <span class="elsevierStyleItalic">M&#46; pneumoniae</span>&#44; SARS-COV-2 and <span class="elsevierStyleItalic">M&#46; pneumoniae&#44;</span> bacterial coinfections and COVID-19&#44; pneumonia and SARS-COV-2&#44; pneumonia and COVID-19&#46; We also used the same terms in Spanish and included articles written in English and Spanish &#40;the primary languages of the investigators&#41;&#46; We also reviewed the reference lists for the articles identified by our search&#44; as well as those of any included studies&#46; We only included those studies using molecular methods for <span class="elsevierStyleItalic">M&#46; pneumoniae</span> detection and excluded all studies employing culture or serology techniques for <span class="elsevierStyleItalic">M&#46; pneumoniae</span> identification&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Data abstraction</span><p id="par0025" class="elsevierStylePara elsevierViewall">Each abstract and the articles selected for full review were evaluated by all investigators&#46; For each included article&#44; the study characteristics and data regarding detection were abstracted by the authors&#46; For detection data&#44; defined cases were included and possible cases were excluded&#46; For each report&#44; the type of surveillance used&#44; number of cases reported and total population studies were documented&#46; This review was conducted and reported according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses &#40;PRISMA&#41; flow-charts &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results and discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The literature search yielded 103 studies&#46; After a first screening&#44; 64 were excluded because they were not related to the subject and 4 were duplicate&#46; After full text reading&#44; 14 studies were included &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Specifically&#44; four of the studies were retrospective and ten were prospective&#46; Most studies were from the USA&#44; Brazil&#44; China and France and the remaining ones from the United Kingdom&#44; Spain&#44; India&#44; Turkey&#44; Peru and Iran&#46; A total of 5855 COVID-19 patients were identified and included in our review &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Concerns regarding coinfections during viral pandemics&#44; specifically coinfections with respiratory bacterial pathogens&#44; are borne from the experience in H1N1 influenza A&#44; Severe Acute Respiratory Syndrome &#40;SARS&#41; and Middle East respiratory syndrome &#40;MERS&#41;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">1&#44;22&#44;33</span></a>&#46; In these outbreaks&#44; as in the COVID-19 pandemic&#44; much lower coinfection rates with <span class="elsevierStyleItalic">M&#46; pneumoniae</span> were reported<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;11&#44;36&#44;39&#44;45</span></a>&#46; The prevalence of reported <span class="elsevierStyleItalic">M&#46; pneumoniae</span> infections in COVID-19 patients ranged from 0&#8211;33&#46;3&#37; in the retrospective studies and 0&#8211;28&#46;1&#37; in the prospective studies&#46; These differences in the proportion of coinfection may be attributable to the selection of case-patients &#40;adults or children&#41;&#44; geographic factors&#44; season and the clinical condition<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">9&#44;10&#44;25&#44;27</span></a>&#46; High prevalence of coinfection between <span class="elsevierStyleItalic">M&#46; pneumoniae</span> and SARS CoV-2 was described using serological methods<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">18&#44;28&#44;47</span></a>&#46; However&#44; these methods are not highly specific tests and may result in an overestimation of infections<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">37</span></a>&#46; In general&#44; the bacterium less frequently found in coinfection with SARS-COV-2 is <span class="elsevierStyleItalic">M&#46; pneumoniae</span><a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;15&#44;16</span></a>&#46; Many of the most recent studies showed that coinfections appeared to be relatively rare&#46; However&#44; due to the variability between countries and the limited country&#47;region representation in the few studies published&#44; the results shown cannot be extrapolated to Latin America&#46; That is why it is important to generate local evidence to support decision-making&#46; In Argentina&#44; only one multicenter study reported the presence of <span class="elsevierStyleItalic">M&#46; pneumoniae</span> in 12&#46;3&#37; &#40;24&#47;187&#41; of COVID-19 patients&#44; using nested-PCR<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In two studies &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; most patients who had contracted a bacterial respiratory infection did not test positive for COVID-19<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;4&#44;24</span></a>&#46; The median age of COVID-19 patients studied for <span class="elsevierStyleItalic">M&#46; pneumoniae</span> was 48 years old &#40;range 1&#8211;107&#41;&#44; most of whom were male<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">2&#44;5&#44;8&#44;21&#44;23&#44;30&#44;34&#44;38</span></a>&#46; This observation is not consistent with the established literature that indicates that community-acquired viral coinfections are more common in younger populations<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The most common clinical symptoms in COVID-19 coinfected patients were fever&#44; cough and dyspnea<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;6&#44;12&#44;21&#44;23&#44;30&#44;38</span></a>&#46; However&#44; these symptoms are similar among COVID-19 monoinfections and coinfections with other pathogens&#44; which made the clinical differentiation difficult&#46; Thus&#44; laboratory confirmation is required&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical presentations of <span class="elsevierStyleItalic">M&#46; pneumoniae</span> range from mild infections affecting the upper respiratory tract to pneumonia that needs hospital admission<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">43</span></a>&#46; It has been proposed that pathogens such as <span class="elsevierStyleItalic">M&#46; pneumoniae</span> can exacerbate clinical symptoms&#44; increase morbidity and prolong the stay in the intensive care unit &#40;ICU&#41; in COVID-19 patients<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;13&#44;23&#44;30&#44;34</span></a>&#46; Boschiero et al&#46;&#44; 2022<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">3</span></a> did not find an association between coinfections and more severe COVID-19-related outcomes in Brazil&#44; while Perez-Lazo et al&#46;&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a> reported a high rate of mortality in Peru &#40;18&#46;1&#37;&#41;&#46; The authors described an elevated development of sepsis in the group with <span class="elsevierStyleItalic">M&#46; pneumoniae</span> coinfections &#40;37&#46;4&#37;&#41;&#59; however&#44; they found that mortality was similar among coinfected and monoinfected groups<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a>&#46; In two studies included in this review a lower mortality rate was found<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">12&#44;23</span></a>&#44; whereas the remaining studies did not report any mortality rates<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">2&#44;3&#44;5&#44;21&#44;34&#44;38</span></a>&#46; Lower rates of comorbidities&#44; such as hypertension&#44; diabetes mellitus&#44; renal disease and obesity<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;30</span></a> were described in coinfected patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Antibiotic use was reported in five studies<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">5&#44;12&#44;23&#44;30&#44;41</span></a>&#44; with &#62;50&#37; of patients receiving empirical antibiotics<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a>&#46; This is particularly important in Latin America&#44; where the abuse of antibiotics in COVID-19 patients has reached alarming levels<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">7&#44;32</span></a>&#46; The finding that there was a low number of patients with bacterial infections&#44; such as <span class="elsevierStyleItalic">M&#46; pneumoniae</span>&#44; <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; highlights the fact that the empirical use of antibiotics in patients with COVID-19 should not be recommended<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">26&#44;29&#44;31&#44;44</span></a>&#46; The COVID-19 pandemic exacerbated the known challenges to optimal antibiotic administration&#44; representing a direct threat to patient safety and public health through antibiotic overprescription and promotion of bacterial resistance&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Unfortunately&#44; there were no specific data on clinical information and therapeutic interventions&#46; Due to the diversity of studies and the low number of patients with detected coinfection with <span class="elsevierStyleItalic">M&#46; pneumoniae</span>&#44; it was difficult to find symptoms indicating coinfection with <span class="elsevierStyleItalic">M&#46; pneumoniae</span> and SARS-CoV-2 in the studies included in our review&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Despite the fact that <span class="elsevierStyleItalic">M&#46; pneumoniae</span> coinfections were searched and infrequently documented in patients with COVID-19 pneumonia&#44; routine testing for respiratory pathogens should be advised&#44; since agents for which specific therapy can be prescribed may be detected and may have a beneficial impact on patient outcomes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical approval</span><p id="par0070" class="elsevierStylePara elsevierViewall">Not required&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1877159"
          "palabras" => array:4 [
            0 => "Infecci&#243;n por SARS-CoV-2"
            1 => "COVID-19"
            2 => "<span class="elsevierStyleItalic">Mycoplasma pneumoniae</span>"
            3 => "Coinfecci&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Understanding the proportion of SARS-CoV-2 patients with <span class="elsevierStyleItalic">Mycoplasma</span><span class="elsevierStyleItalic">pneumoniae</span> coinfection is crucial for treating patients suffering from coronavirus disease &#40;COVID-19&#41;&#44; help to ensure responsible use of antibiotics and minimize the negative consequences of overuse&#46; In addition&#44; this knowledge could have an impact on empirical antibiotic management guidelines for patients with COVID-19&#46; This systematic review aimed to identify the prevalence of <span class="elsevierStyleItalic">M&#46; pneumoniae</span> in patients with coronavirus disease 2019 &#40;COVID-19&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A bibliographic search of studies published in Spanish or English was conducted using the PubMed search engine&#46; Fourteen articles from different continents &#40;America&#44; Asia and Europe&#41; were included&#44; involving a total of 5855 patients in these studies&#46; The mean age of COVID-19 patients with <span class="elsevierStyleItalic">M&#46; pneumoniae</span> was 48 years old &#40;range 1&#8211;107&#41;&#44; most of whom were male&#46; The detection of laboratory-confirmed <span class="elsevierStyleItalic">M&#46; pneumoniae</span> infection varied between 0 and 33&#46;3&#37;&#46; Most of patients referred fever&#44; cough&#44; and dyspnea&#44; and received empirical antibiotic treatment&#46; Bacterial coinfection was not associated with increased ICU admission and mortality&#46; The prevalence of coinfection showed extremely dissimilar figures according to the population studied and diagnostic criteria&#46; However&#44; it is important to develop Latin American studies&#44; given the heterogeneity observed in the studies conducted in different countries&#46; Standardized definitions should be developed in order to be able to assess the impact of coinfections in patients with a diagnosis of COVID-19&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Comprender la proporci&#243;n de coinfecci&#243;n por coronavirus &#40;COVID-19&#41; y <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> es crucial para tratar a los pacientes con COVID-19&#44; garantizando el empleo responsable de antibi&#243;ticos y minimizando las consecuencias negativas del uso excesivo&#46; Adem&#225;s&#44; este conocimiento podr&#237;a tener un impacto en las pautas de manejo emp&#237;rico de antibi&#243;ticos en pacientes con COVID-19&#46; Esta revisi&#243;n sistem&#225;tica tuvo como objetivo identificar la prevalencia de <span class="elsevierStyleItalic">M&#46; pneumoniae</span> en pacientes con COVID-19&#46; Para ello se realiz&#243; una b&#250;squeda bibliogr&#225;fica de estudios publicados en espa&#241;ol o ingl&#233;s utilizando el buscador PubMed&#46; Se incluyeron 14 art&#237;culos de diferentes continentes &#40;Am&#233;rica&#44; Asia y Europa&#41;&#44; con un total de 5855 pacientes estudiados&#46; La media de edad de los pacientes COVID-19 con <span class="elsevierStyleItalic">M&#46; pneumoniae</span> fue de 48 a&#241;os &#40;intervalo&#58; 1 a 107 a&#241;os&#41; y la mayor&#237;a de ellos fueron varones&#46; La detecci&#243;n de <span class="elsevierStyleItalic">M&#46; pneumoniae</span> confirmada por laboratorio en pacientes con COVID-19 vari&#243; del 0 al 33&#44;3&#37;&#46; La mayor&#237;a de los pacientes refirieron fiebre&#44; tos y disnea&#44; y recibieron antibi&#243;ticos emp&#237;ricos&#46; La coinfecci&#243;n bacteriana no se asoci&#243; con un aumento de la admisi&#243;n en UCI ni de la mortalidad&#46; La prevalencia de coinfecci&#243;n fue muy dis&#237;mil seg&#250;n la poblaci&#243;n estudiada y los criterios diagn&#243;sticos empleados&#46; Dada la heterogeneidad de resultados en los diferentes pa&#237;ses&#44; es importante desarrollar estudios en Am&#233;rica Latina&#44; como as&#237; tambi&#233;n establecer definiciones estandarizadas para poder evaluar el impacto real de las coinfecciones en pacientes con COVID-19&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:3 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Grupo de Trabajo Bacterias At&#237;picas&#44; Sociedad Argentina de Bacteriolog&#237;a&#44; Micolog&#237;a y Parasitolog&#237;a Cl&#237;nicas &#40;SADEBAC&#41;&#44; Divisi&#243;n de la Asociaci&#243;n Argentina de Microbiolog&#237;a&#46;</p>"
      ]
      1 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">These first authors contributed equally to this work&#46;</p>"
        "identificador" => "fn0005"
      ]
      2 => array:3 [
        "etiqueta" => "2"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">These authors contributed equally to this work&#46;</p>"
        "identificador" => "fn0010"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1942
            "Ancho" => 2471
            "Tamanyo" => 236472
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PRISMA flow-chart&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overall rate of coinfection &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">M&#46; pneumomiae</span>&#47;SARS-CoV-2 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic methods&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcomes of COVID19&#47;<span class="elsevierStyleItalic">M&#46; pneumoniae</span> patients &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blasco et al&#46;&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;103 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;3 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiplex PCR assay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Boschiero et al&#46;&#44; 2022<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#47;1503 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;84 &#40;2&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;respiratory pathogen panel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chaudry et al&#46;&#44; 2022<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;194 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;17 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;CARDS toxin gene&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azithromycin&#44; or fluoroquinolones&#44; or doxycycline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chi et al&#46;&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;17 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiplex PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contou et al&#46;&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">France&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;92 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;26 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;respiratory pathogen panel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Easom et al&#46;&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#47;67 &#40;43&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;67 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiplex PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxycycline and monofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hazra et al&#46;&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;459 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;459 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;respiratory pathogen panel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Husain et al&#46;&#44; 2022<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">France&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;784 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;22 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiplex PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Karaaslan et al&#46;&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;93 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;93 &#40;1&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azithromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kim et al&#46;&#44; 2020<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;115 &#40;20&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;116 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;respiratory pathogen panel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#233;rez-Lazo et al&#46;&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peru&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&#47;295 &#40;52&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#47;295 &#40;28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azithromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;18&#46;1&#41; died&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Richardson et al&#46; 2020<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#47;1996 &#40;2&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;42 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;respiratory pathogen panel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Soltani et al&#46;&#44; 2021<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iran&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;40 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;40 &#40;22&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR &#40;P1 adhesion gene&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Varela et al&#46;&#44; 2022<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#47;97 &#40;31&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;31 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT-PCR &#40;respiratory pathogen panel&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azithromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3657417.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Years &#40;mean&#41;&#46; NR&#58; not reported&#46; NA&#58; not applicable&#46; <span class="elsevierStyleItalic">M&#46; pneumoniae</span>&#58; <span class="elsevierStyleItalic">Mycoplasma</span><span class="elsevierStyleItalic">pneumonia</span>e&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Summary of studies reporting the incidence of <span class="elsevierStyleItalic">M&#46; pneumoniae</span> co- and secondary infection among COVID-19 patients&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.diagmicrobio.2021.115576"
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                      "autores" => array:1 [
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                            1 => "V&#46; Ghisetti"
                            2 => "E&#46; Burdino"
                            3 => "M&#46; Trunfio"
                            4 => "T&#46; Allice"
                            5 => "L&#46; Boglione"
                            6 => "S&#46; Bonora"
                            7 => "G&#46; Di Perri"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cmi.2020.08.012"
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                          "etal" => false
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                            0 => "R&#46; Chaudhry"
                            1 => "K&#46; Sreenath"
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                            4 => "N&#46; Rathor"
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                            6 => "A&#46; Aravindan"
                            7 => "V&#46; Singh"
                            8 => "M&#46; Brijwal"
                            9 => "M&#46; Soneja"
                            10 => "N&#46; Verma"
                            11 => "R&#46; Subramanium"
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                  ]
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                            1 => "A&#46; Claudinon"
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                            5 => "M&#46; Dubert"
                            6 => "R&#46; Cally"
                            7 => "E&#46; Logre"
                            8 => "M&#46; Fraiss&#233;"
                            9 => "H&#46; Mentec"
                            10 => "G&#46; Plantef&#232;ve"
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                  ]
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                  ]
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            11 => array:3 [
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "N&#46; Easom"
                            1 => "P&#46; Moss"
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Article information

ISSN: 03257541
Original language: English

DOI:10.1016/j.ram.2024.05.002

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