Epidemiological Impact on Use of Antibiotics in Patients Hospitalized for COVID-19: A Retrospective Cohort Study in Italy.

The increased incidence of antimicrobial resistance during coronavirus disease 2019 (COVID-19) is a very important collateral damage of global concern. The cause is multifactorial and is particularly related to the high rates of antibiotic use in COVID-19 patients with a relatively low rate of secondary co-infection. To this end, we conducted a retrospective observational study of 1269 COVID-19 patients admitted during the years 2020, 2021 and 2022 in two Italian hospitals, with a focus on bacterial co-infections and antimicrobial therapy. Multivariate logistic regression was used to analyze the association between bacterial co-infection, antibiotic use and hospital death after adjustment for age and comorbidity. Bacterial co-infection was detected in 185 patients. The overall mortality rate was 25% (n = 317). Concomitant bacterial infections were associated with increased hospital mortality (ß = 1.002, p < 0.001). A total of 83.7% (n = 1062) of patients received antibiotic therapy, but only 14.6% of these patients had an obvious source of bacterial infection. There was a significantly higher rate of hospital mortality in patients who received antibiotics than in those who did not (χ2 = 6.22, p = 0.012). Appropriate prescribing and the rational use of antimicrobials according to the principles of antimicrobial stewardship can help prevent the emergence of antibiotic resistance.

Predictive values of procalcitonin for coinfections in patients with COVID-19: a systematic review and meta-analysis.

OBJECTIVES: To assess the ability of procalcitonin (PCT)-a promising marker for coinfections-to predict coinfections in patients with COVID-19. METHODS: In this systematic review and meta-analysis, PubMed, Embase, Web of Science, Cochrane, the China National Knowledge Infrastructure (CNKI), and Wanfang were searched to identify eligible studies (up to August 30, 2021). Articles that reported the predictive value of PCT for coinfections in patients with COVID-19 were included. Individual and pooled sensitivities and specificities were reported, and I2 was used to test heterogeneity. This study was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number: CRD42021283344). RESULTS: Five studies involving a total of 2775 patients reported the predictive value of PCT for coinfections in patients with COVID-19. The sensitivity, specificity, and area under the curve of PCT in predicting coinfections in the pooled studies were 0.60 (95% CI 0.35-0.81, I2 = 88.85), 0.71 (95% CI 0.58-0.81, I2 = 87.82), and 0.72(95% CI 0.68-0.76) respectively. CONCLUSIONS: Although PCT has limited predictive value for coinfections in patients with COVID-19, lower PCT levels seem to indicate a decreased probability of having a coinfection.

Increased Mortality with Co-existence of Crimean-Congo Hemorrhagic Fever and COVID-19

Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease with fever and bleeding caused by a tick-borne virus belonging to the Bunyaviridae family. Coronavirus disease-2019 (COVID-19) is a novel disease caused by Severe Acute Respiratory Syndrome Coronavirus Type 2, which can lead to acute respiratory distress syndrome (ARDS). Here, we present a case with CCHF and COVID-19 co-infection to draw attention to the increased mortality in co-infection cases. A 77-year-old female patient with known hypertension was admitted to the emergency department with complaints of fever, nausea, vomiting, diarrhea, and myalgia for two days. There was no history of tick bite or contact with a patient with COVID-19. Current anamnesis and clinical and laboratory findings pre-diagnose the patient with CCHF, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura, leading to a ward admission. Crimean-Congo hemorrhagic fever was diagnosed after receiving a positive CCHF immunoglobulin M (indirect fluorescent antibody) result. A nasopharyngeal swab sample for COVID-19 real-time polymerase time reaction was sent due to a continuous fever and the development of shortness of breath on day three of hospitalization, which revealed positive results;thus, the patient was started on favipiravir treatment. The patient was transferred to the intensive care unit on day four due to increased oxygen demand and ARDS diagnosis. The patient died due to respiratory failure on the seventh day of hospitalization. COVID-19-related ARDS that overlapped on top of CCHF caused her to develop a cytokine storm and died despite her clinical parameter improvement due to CCHF. Crimean-Congo hemorrhagic fever and COVID-19 symptoms or findings can be confused because of their similarities, but the possibility of being seen together should not be overlooked. Concurrently, some similarities in the pathogenesis of these two diseases suggest that co-infection may worsen the clinical course;hence, new studies are needed on this subject.

Urinary Tract infections: Urinary Schistosomiasis

Urogenital schistosomiasis is a neglected tropical disease affecting approximately a quarter of a million people in the world. A lot of research on the disease has focused on school age children with very limited studies in preschool age children (PSAC). Schistosome control programs targeting PSAC should take into consideration other factors affecting this age group such as malnutrition, co-infections, underlying inflammatory conditions as well as the fact that this is the age group receiving childhood vaccinations. Praziquantel is the only drug currently being used for the treatment of schistosomiasis. However, there needs to be more research on the appropriate dosage and safety for the PSAC. Allergic conditions have been shown to be less prevalent in areas where parasitic infections are prevalent. When carrying out mass drug administration (MDA) programs considerations on the effects of treatment on allergy should be taken. COVID-19 has affected MDA programs and continues to do so. The lessons learnt and effects of COVID-19 on schistosomiasis need to be investigated. © 2022 Elsevier Inc. All rights reserved.

Surveillance of Influenza and Other Airborne Transmission Viruses during the 2021/2022 Season in Hospitalized Subjects in Tuscany, Italy.

Winter in the northern hemisphere is characterized by the circulation of influenza viruses, which cause seasonal epidemics, generally from October to April. Each influenza season has its own pattern, which differs from one year to the next in terms of the first influenza case notification, the period of highest incidence, and the predominant influenza virus subtypes. After the total absence of influenza viruses in the 2020/2021 season, cases of influenza were again recorded in the 2021/2022 season, although they remained below the seasonal average. Moreover, the co-circulation of the influenza virus and the SARS-CoV-2 pandemic virus was also reported. In the context of the DRIVE study, oropharyngeal swabs were collected from 129 Tuscan adults hospitalized for severe acute respiratory infection (SARI) and analyzed by means of real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and 21 different airborne pathogens, including influenza viruses. In total, 55 subjects tested positive for COVID-19, 9 tested positive for influenza, and 3 tested positive for both SARS-CoV-2 and the A/H3N2 influenza virus. The co-circulation of different viruses in the population requires strengthened surveillance that is no longer restricted to the winter months. Indeed, constant, year-long monitoring of the trends of these viruses is needed, especially in at-risk groups and elderly people.

Incidence of SARS-CoV-2 Co-infections During the Second Wave in Sub-Himalayan Region, India.

Introduction The second wave of the coronavirus disease 2019 (COVID-19) pandemic in India, which started from April 2021, has been more severe and deadly than the first wave. The aim of this prospective study was to determine the possibility of other respiratory pathogens contributing towards the severity and hospitalization in the current second wave. Materials and methods Nasopharyngeal and oropharyngeal swab samples were collected and processed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR). These samples were further processed for detection of co-infection in SARS CoV-2 patients by BioFire® Filmarray® 2.0 (bioMérieux, USA). Results We screened 77 COVID-19-positive patients admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh and found cases of co-infections in five (6.49 %) patients. Conclusion Our finding suggests that co-infections had no or minimal role in augmenting the second wave of the COVID-19 pandemic in India, and the emergence of new variants may be the probable cause.

Coronavirus Disease-2019 (COVID-19)-Positive Patients as Susceptible Hosts to Severe Fungal Coinfections

Since the World Health Organization (WHO) declared the pandemic of coronavirus disease-2019 (COVID-19) on March 11th, 2020, the world has faced a health crisis that includes challenges such as its diagnosis, treatment and prevention, resulting in more than 595 million confirmed cases worldwide and more than 6.4 million deaths (August 25th, 2022). The infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to the suppression of the immune system, particularly due to the storm of inflammatory cytokines (e.g., TNF-α, IFN-γ, IL-6, IL-2 and IL-1) and the reduction of anti-inflammatory cells (e.g., CD4+ and CD8+ T lymphocytes). These factors, when associated with the use of steroids, prolonged stay in the intensive care unit (ICU), older age, diabetes, cardiovascular and pulmonary diseases as well as inherited and acquired immunodeficiency, contribute to the colonization of other infectious agents, such as respiratory viruses, gram-positive and gram-negative bacteria, yeasts and filamentous fungi. The incidence of opportunistic fungal infections has increased significantly in patients with COVID-19, especially in individuals with critical medical conditions and presenting comorbidities, such as the ones cited above. The main fungal agents causing coinfections in these particular patients are Aspergillus spp., Candida spp. and fungi belonging to the order Mucorales. The similarity of clinical symptoms between COVID-19 and fungal infections, such as fever, dry cough, dyspnea, myalgia and headache, makes it harder to get a conclusive laboratory identification and diagnosis, which represents a challenge for treatment. To worsen this bad scenario, the available antifungals are substantially limited and some fungal species are intrinsically resistant to classical chemotherapeutic drugs used in the clinical settings. In parallel, the antifungals can also present drug interactions besides serious and severe side effects, such as hepatotoxicity and nephrotoxicity, which can greatly aggravate the patients' clinical condition. All these facts highlight the urgent need for early diagnosis of the fungal pathogens for the proper choice of antifungal treatment in order to combat these relevant yet still neglected diseases on a global scale. The present chapter focused on summarizing the main fungal infections reported in COVID-19-positive patients. © 2023 Nova Science Publishers, Inc.

Bacterial Co-Infections and Antimicrobial Resistance in Patients Hospitalized with Suspected or Confirmed COVID-19 Pneumonia in Kazakhstan.

Our study was carried out to characterize respiratory tract microbiota in patients with "COVID-like pneumonia" in Kazakhstan and analyze differences between COVID-19 positive and negative groups. Sputum samples were collected from hospitalized patients, ≥18 years old, in the three cities in Kazakhstan with the highest COVID-19 burden in July 2020. Isolates were identified by MALDI-TOF MS. Susceptibility testing was performed by disk diffusion. We used SPSS 26 and MedCalc 19 for statistical analysis. Among 209 patients with pneumonia, the median age was 62 years and 55% were male. RT-PCR-confirmed SARS-CoV-2 cases were found in 40% of patients, and 46% had a bacterial co-infection. Co-infection was not associated with SARS-CoV-2 RT-PCR test results, but antibiotic use was. The most frequent bacteria were Klebsiella pneumoniae (23%), Escherichia coli (12%), and Acinetobacter baumannii (11%). Notably, 68% of Klebsiella pneumoniae had phenotypic evidence of extended-spectrum beta-lactamases in disk diffusion assays, 87% of Acinetobacter baumannii exhibited resistance to beta-lactams, and >50% of E. coli strains had evidence of ESBL production and 64% were resistant to fluoroquinolones. Patients with a bacterial co-infection had a higher proportion of severe disease than those without a co-infection. The results reinforce the importance of using appropriate targeted antibiotics and effective infection control practices to prevent the spread of resistant nosocomial infections.

Microbial and clinical epidemiology of invasive fungal rhinosinusitis in hospitalized COVID-19 patients, the divergent causative agents.

Since COVID-19 spread worldwide, invasive fungal rhinosinusitis (IFRS) has emerged in immunocompromised patients as a new clinical challenge. In this study, clinical specimens of 89 COVID-19 patients who presented clinical and radiological evidence suggestive of IFRS were examined by direct microscopy, histopathology, and culture, and the isolated colonies were identified through DNA sequence analysis. Fungal elements were microscopically observed in 84.27% of the patients. Males (53.9%) and patients over 40 (95.5%) were more commonly affected than others. Headache (94.4%) and retro-orbital pain (87.6%) were the most common symptoms, followed by ptosis/proptosis/eyelid swelling (52.8%), and 74 patients underwent surgery and debridement. The most common predisposing factors were steroid therapy (n = 83, 93.3%), diabetes mellitus (n = 63, 70.8%), and hypertension (n = 42, 47.2%). The culture was positive for 60.67% of the confirmed cases, and Mucorales were the most prevalent (48.14%) causative fungal agents. Different species of Aspergillus (29.63%) and Fusarium (3.7%) and a mix of two filamentous fungi (16.67%) were other causative agents. For 21 patients, no growth was seen in culture despite a positive result on microscopic examinations. In PCR-sequencing of 53 isolates, divergent fungal taxons, including 8 genera and 17 species, were identified as followed: Rhizopus oryzae (n = 22), Aspergillus flavus (n = 10), A. fumigatus (n = 4), A. niger (n = 3), R. microsporus (n = 2), Mucor circinelloides, Lichtheimia ramosa, Apophysomyces variabilis, A. tubingensis, A. alliaceus, A. nidulans, A. calidoustus, Fusarium fujikuroi/proliferatum, F. oxysporum, F. solani, Lomentospora prolificans, and Candida albicans (each n = 1). In conclusion, a diverse set of species involved in COVID-19-associated IFRS was observed in this study. Our data encourage specialist physicians to consider the possibility of involving various species in IFRS in immunocompromised and COVID-19 patients. In light of utilizing molecular identification approaches, the current knowledge of microbial epidemiology of invasive fungal infections, especially IFRS, may change dramatically.

Invasive fungal rhinosinusitis (IFRS) may infect people with diabetes, cancer, or COVID-19. In this study, various types of fungi were identified from COVID-19-associated-IFRS, encouraging physicians to consider specific treatments.

Viral co-infection with human respiratory syncytial virus in suspected acute and severe respiratory tract infections during COVID-19 pandemic in Yaoundé, Cameroon, 2020-2021.

BACKGROUND: Acute lower respiratory tract infections (ALRIs) are one one of the leading causes of morbidity and mortality among people of all ages worldwide, particularly in low- and middle-income countries (LMICs). The purpose of this study was to determine epidemiological characteristics of respiratory viruses in acute respiratory infection (ARI) patients during the COVID-19 pandemic in Yaoundé, Cameroon. METHODS: Patients were monitored for respiratory symptoms as part of the surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viral infections. Patients of all ages with respiratory symptoms less than 5 days were considered. Sociodemographic and clinical data as well as nasopharyngeal samples was collected from patients. Nasopharyngeal samples were tested for SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) using real-time reverse-transcription polymerase chain reaction methods. Virus distribution and demographic data were analyzed with R version 2.15.1. RESULTS: From July 2020 to October 2021, 1120 patients were included. The overall viral detection rate was 32.5%, including 9.5% for RSV, 12.6% for influenza virus and 12.8% for SARS-CoV-2. Co-infections were detected in 6.9% of positive cases. While RSV and influenza virus showed seasonal trends, SARS-CoV-2 was detected throughout the study period. CONCLUSION: We found that during COVID-19 pandemic, respiratory viruses play an important role in etiology of influenza-like illness in Cameroon, and this observation was true for patients of all ages.

Can photocatalysis help in the fight against COVID-19 pandemic?

Mould fungi are serious threats to humans and animals (allergen) and might be the main cause of COVID-19-associated pulmonary aspergillosis. The common methods of disinfection are not highly effective against fungi due to the high resistance of fungal spores. Recently, photocatalysis has attracted significant attention towards antimicrobial action. Outstanding properties of titania photocatalysts have already been used in many areas, e.g., for building materials, air conditioner filters, and air purifiers. Here, the efficiency of photocatalytic methods to remove fungi and bacteria (risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 co-infection) is presented. Based on the relevant literature and own experience, there is no doubt that photocatalysis might help in the fight against microorganisms, and thus prevent the severity of COVID-19 pandemic.

The Impact of Coronavirus Disease 2019 on Viral, Bacterial, and Fungal Respiratory Infections.

Although coronavirus disease 2019 (COVID-19) remains an ongoing threat, concerns regarding other respiratory infections remain. Throughout the COVID-19 pandemic various epidemiologic trends have been observed in other respiratory viruses including a reduction in influenza and respiratory syncytial virus infections following onset of the COVID-19 pandemic. Observations suggest that infections with other respiratory viruses were reduced with social distancing, mask wearing, eye protection, and hand hygiene practices. Coinfections with COVID-19 exist not only with other respiratory viruses but also with bacterial pneumonias and other nosocomial and opportunistic infections. Coinfections have been associated with increased severity of illness and other adverse outcomes.

Global asymptotic stability, extinction and ergodic stationary distribution in a stochastic model for dual variants of SARS-CoV-2

Several mathematical models have been developed to investigate the dynamics SARS-CoV-2 and its different variants. Most of the multi-strain SARS-CoV-2 models do not capture an important and more realistic feature of such models known as randomness. As the dynamical behavior of most epidemics, especially SARS-CoV-2, is unarguably influenced by several random factors, it is appropriate to consider a stochastic vaccination co-infection model for two strains of SARS-CoV-2. In this work, a new stochastic model for two variants of SARS-CoV-2 is presented. The conditions of existence and the uniqueness of a unique global solution of the stochastic model are derived. Constructing an appropriate Lyapunov function, the conditions for the stochastic system to fluctuate around endemic equilibrium of the deterministic system are derived. Stationary distribution and ergodicity for the new co-infection model are also studied. Numerical simulations are carried out to validate theoretical results. It is observed that when the white noise intensities are larger than certain thresholds and the associated stochastic reproduction numbers are less than unity, both strains die out and go into extinction with unit probability. More-over, it is observed that, for weak white noise intensities, the solution of the stochastic system fluctuates around the endemic equilibrium (EE) of the deterministic model. Frequency distributions are also studied to show random fluctuations due to stochastic white noise intensities. The results presented herein also reveal the impact of vaccination in reducing the co-circulation of SARS-CoV-2 variants within a given population. © 2022 International Association for Mathematics and Computers in Simulation (IMACS)

A multiplex-NGS approach to identifying respiratory RNA viruses during the COVID-19 pandemic.

A methodological approach based on reverse transcription (RT)-multiplex PCR followed by next-generation sequencing (NGS) was implemented to identify multiple respiratory RNA viruses simultaneously. A convenience sampling from respiratory surveillance and SARS-CoV-2 diagnosis in 2020 and 2021 in Montevideo, Uruguay, was analyzed. The results revealed the cocirculation of SARS-CoV-2 with human rhinovirus (hRV) A, B and C, human respiratory syncytial virus (hRSV) B, influenza A virus, and metapneumovirus B1. SARS-CoV-2 coinfections with hRV or hRSV B and influenza A virus coinfections with hRV C were identified in adults and/or children. This methodology combines the benefits of multiplex genomic amplification with the sensitivity and information provided by NGS. An advantage is that additional viral targets can be incorporated, making it a helpful tool to investigate the cocirculation and coinfections of respiratory viruses in pandemic and post-pandemic contexts.

Co-infection associated with SARS-CoV-2 and their management.

SARS-CoV-2 was discovered in Wuhan, China and quickly spread throughout the world. This deadly virus moved from person to person, resulting in severe pneumonia, fever, chills and hypoxia. Patients are still experiencing problems after recovering from COVID-19. This review covers COVID-19 and associated issues following recovery from COVID-19, as well as multiorgan damage risk factors and treatment techniques. Several unusual illnesses, including mucormycosis, white fungus infection, happy hypoxia and other systemic abnormalities, have been reported in recovered individuals. In children, multisystem inflammatory syndrome with COVID-19 (MIS-C) is identified. The reasons for this might include uncontrollable steroid usage, reduced immunity, uncontrollable diabetes mellitus and inadequate care following COVID-19 recovery.

COVID-19 infection has reported in the development several other infections and co-morbidity in patients. The present review discusses risk and management strategies in patients suffeting from co-infections caused by COVID-19 infection.

Impact of Bacterial Infections on COVID-19 Patients: Is Timing Important?

BACKGROUND: Along with important factors that worsen the clinical outcome of COVID-19, it has been described that bacterial infections among patients positive for a SARS-CoV-2 infection can play a dramatic role in the disease process. Co-infections or community-acquired infections are recognized within the first 48 h after the admission of patients. Superinfections occur at least 48 h after admission and are considered to contribute to a worse prognosis. Microbiologic parameters differentiate infections that happen after the fifth day of hospitalization from those appearing earlier. Specifically, after the fifth day, the detection of resistant bacteria increases and difficult microorganisms emerge. OBJECTIVES: The aim of the study was to evaluate the impact of bacterial infections in patients with COVID-19 on the length of the hospital stay and mortality. METHODS: A total of 177 patients hospitalized due to COVID-19 pneumonia were consecutively sampled during the third and fourth wave of the pandemic at a University Hospital in Greece. A confirmed bacterial infection was defined as positive blood, urinary, bronchoalveolar lavage (BAL) or any other infected body fluid. Patients with confirmed infections were further divided into subgroups according to the time from admission to the positive culture result. RESULTS: When comparing the groups of patients, those with a confirmed infection had increased odds of death (odds ratio: 3.634; CI 95%: 1.795-7.358; p < 0.001) and a longer length of hospital stay (median 13 vs. 7 days). A late onset of infection was the most common finding in our cohort and was an independent risk factor for in-hospital death. Mortality and the length of hospital stay significantly differed between the subgroups. CONCLUSION: In this case series, microbial infections were an independent risk factor for a worse outcome among patients with COVID-19. Further, a correlation between the onset of infection and a negative outcome in terms of non-infected, community-acquired, early hospital-acquired and late hospital-acquired infections was identified. Late hospital-acquired infections increased the mortality of COVID-19 patients whilst superinfections were responsible for an extended length of hospital stay.

The clinical and virological features of two children's coinfections with human adenovirus type 7 and human coronavirus-229E virus.

Objective: Human adenovirus (HAdV) coinfection with other respiratory viruses is common, but adenovirus infection combined with human coronavirus-229E (HCoV-229E) is very rare. Study design and setting: Clinical manifestations, laboratory examinations, and disease severity were compared between three groups: one coinfected with HAdV-Ad7 and HCoV-229E, one infected only with adenovirus (mono-adenovirus), and one infected only with HCoV-229E (mono-HCoV-229E). Results: From July to August 2019, there were 24 hospitalized children: two were coinfected with HAdV-Ad7 and HCoV-229E, and 21 were infected with a single adenovirus infection. Finally, one 14-year-old boy presented with a high fever, but tested negative for HAdV-Ad7 and HCoV-229E. Additionally, three adult asymptotic cases with HCoV-229E were screened. No significant difference in age was found in the coinfection and mono-adenovirus groups (11 vs. 8 years, p = 0.332). Both groups had the same incubation period (2.5 vs. 3 days, p = 0.8302), fever duration (2.5 vs. 2.9 days, p = 0.5062), and length of hospital stay (7 vs. 6.76 days, p = 0.640). No obvious differences were found in viral loads between the coinfection and mono-adenovirus groups (25.4 vs. 23.7, p = 0.570), or in the coinfection and mono-HCoV-229E groups (32.9 vs. 30.06, p = 0.067). All cases recovered and were discharged from the hospital. Conclusion: HAdV-Ad7 and HCoV-229E coinfection in healthy children may not increase the clinical severity or prolong the clinical course. The specific interaction mechanism between the viruses requires further study.

COVID­19 and peritonsillar abscess co­infection: A case report.

Coronavirus disease 2019 (COVID-19) generally presents with fever, shortness of breath and a sore throat. These symptoms are also common in oral and pharyngeal infections, such as peritonsillar abscess (PA). The present study describes a case of PA and COVID-19 co-infection. Although COVID-19 was initially suspected in the patient due to the presenting symptoms of fever, sore throat, dysgeusia and dysosmia, an oral examination and computed tomography scan detected PA. The patient was conservatively managed with intravenous antibiotics without transoral drainage of the abscess. Anti-COVID-19 medication was not administered as the COVID-19 infection in the patient was not severe. Laboratory findings revealed high levels of leukocytes, C-reactive protein (CRP) and procalcitonin. On the whole, the association between laboratory findings (including leukocyte count, CRP and procalcitonin levels) and bacterial co-infection with COVID-19 remains unclear, and further studies are warranted. Oral examinations and transoral procedures are often avoided due to the high risk of the aerosolisation of COVID-19 viral particles. However, an appropriate evaluation is essential in order to avoid the underdiagnosis of life-threatening bacterial infections that co-exist with COVID-19.

Staphylococcal Scalded Skin Syndrome Superinfection in a Child with COVID-19: A Brief Case Report

Background: While the exact prevalence of bacterial co-infection and superinfection in children with coronavirus disease 2019 (COVID-19) remains unclear, numerous scattered reports of it are on the rise. Case Presentation: Our case was a 14-month-old infant with fever, truncal erythema, and scalded skin in flexor folds and also in perianal and perioral regions. A positive Nikolsky's sign was observed. The oropharyngeal mucosa was intact. The patient was diagnosed with staphylococcal scalded skin syndrome (SSSS) according to clinical features and a skin culture report. Due to the general impact of COVID-19 these days, the patient was evaluated for coronavirus via a polymerase chain reaction (PCR) test, and the result was positive. The patient successfully responded to the treatment which included hydration, wet compress, topical emollient, topical mupirocin for periorificial regions, and intravenous clindamycin. He was discharged after nine days without any complications. Conclusion(s): This case highlights a clear bacterial infection superimposed on COVID-19. Nevertheless, inconspicuous cases of co-infections remain obscure and require a more diagnostic suspicion. Copyright © 2022 Hoseininasab et al.