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Bacterial and Viral Coinfections in Adult Patients Hospitalized With COVID-19 Throughout the Pandemic: A
Pontus Hedberg1, Karol Serwin2, Maria Francesca Greco3
1Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Background:
Limited evidence exists on how bacterial and viral coinfections have developed since the SARS-CoV-2 Omicron variant emerged. We investigated whether community-onset coinfections in adult patients hospitalized with COVID-19 differed during the wild type, Alpha, Delta, and Omicron periods and whether such coinfections were associated with an increased risk of mortality.
Methods:
We conducted a multinational cohort study including COVID-19 hospitalizations until 30 April 2023 in 5 European countries. The outcome was bacterial and viral coinfections based on 5 test modalities. Variant periods were compared with regard to occurrences of coinfections and risk ratios for coinfections (Omicron vs pre-Omicron), as well as association with in-hospital mortality (Omicron vs pre-Omicron).
Results:
A total of 29 564 cases were included: 12 601 wild type, 5256 Alpha, 2433 Delta, and 9274 Omicron. The coinfection rate was 2.6% (327/12 601) for wild type, 2.0% (105/5256) for Alpha, 3.2% (77/2433) for Delta, and 7.9% (737/9274) for Omicron. Omicron had a significantly increased risk ratio of coinfection when compared with preceding variants (1.88 [95% CI, 1.53-2.32], P < .001). These results were consistent across several subgroup analyses. An increased occurrence (19% [232/1246] vs 11% [3042/28 318]) and adjusted risk (1.69 [95% CI, 1.49-1.91], P < .001) of in-hospital mortality were observed in patients with a verified coinfection as compared with patients without a coinfection.
Conclusions:
Bacterial and viral coinfections were more prevalent during the Omicron period as compared with preceding variants. Such coinfections were associated with an increased risk of in-hospital mortality, calling for sustained monitoring and clinical vigilance.
Insights
Bacterial and viral co-infections were more common during the Omicron variant period. These co-infections significantly increased the risk of in-hospital mortality for COVID-19 patients.
Area of Science:
- Infectious Diseases
- Virology
- Epidemiology
Background:
- Limited data exists on bacterial and viral co-infections post-SARS-CoV-2 Omicron emergence.
- Investigated co-infection prevalence and mortality risk across COVID-19 variant periods.
Purpose of the Study:
- Compare community-onset co-infection rates in hospitalized COVID-19 patients across Wild type, Alpha, Delta, and Omicron variants.
- Assess the association between co-infections and in-hospital mortality during the Omicron versus pre-Omicron periods.
Main Methods:
- Multinational cohort study of COVID-19 hospitalizations up to April 2023.
- Analyzed bacterial and viral co-infections using five test modalities.
- Compared co-infection occurrence and mortality risk ratios between Omicron and pre-Omicron periods.
Main Results:
- Co-infection rates: Wild type (2.6%), Alpha (2.0%), Delta (3.2%), Omicron (7.9%).
- Omicron variant showed a significantly increased risk ratio for co-infection (1.88).
- Co-infected patients had higher in-hospital mortality (19% vs 11%) with an adjusted risk of 1.69.
Conclusions:
- Bacterial and viral co-infections were more prevalent during the Omicron period.
- Co-infections significantly increased the risk of in-hospital mortality.
- Sustained monitoring and clinical vigilance for co-infections are crucial.
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