ArticleInfection2026
Postmortem analysis of secondary infections in a German cohort of patients following COVID-19 infection.
Article in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
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Abstract
purposeThis retrospective study analyses secondary infections found in post mortem autopsies in patients with COVID-19 and their contribution to the causes of death.
methodsDeath certificates and reports of clinically requested autopsies of hospitalised COVID-19 positive cases were retrospectively analysed for documented evidence of secondary infections. Type of infections, pathogens, patient demographics and comorbidities were recorded and data analysed using descriptive statistics.
resultsA total of 120 COVID-19 deaths underwent a clinically requested autopsy. Most cases (71.6%; 86/120) were hospitalised in the ICU. Within this cohort of deaths 17.5% (21/120) had evidence of a secondary infection of which 57% contributed directly to the cause of death. All secondary infection cases had at least two or more comorbidities and were significantly more immunosuppressed compared to the COVID-19 control group (p = 0.017). A total of 52.4% of the infections were due to bacteria (S. pneumoniae, S. aureus, Staphylococcus sp. Enterococcus spp., K. pneumoniae, K. oxytoca and E. coli) which presented in 47.6% of cases as pneumonia and 14.3% had a documented bacteraemia. Viral pneumonitis was detected in 19% due to viruses such as herpes simplex virus and Cytomegaly virus. Invasive fungal infection made up 47.6% of the infections which were documented as fungal pneumonia (23.8%) including invasive pulmonary aspergillosis, tracheobronchitis (14.3%) and invasive candidiasis (14.3%).
conclusionSecondary infections contribute to the cause of death in a high percentage of hospitalised COVID-19 patients. Autopsies are essential in understanding the role of such infections and may help to guide policies for early diagnosis and therapeutic interventions particularly within high-risk groups.
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