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Bacterial co-detection in individuals with acute respiratory infections through a direct-to-consumer platform in
Chunyan Xiang1, Jingya Li2, Mengwei Yan1
1Capital Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Background:
Although bacterial co-detection is frequently observed in individuals with viral acute respiratory infections, little is known about its epidemiological profile among the broader population in the community. By leveraging a large platform of direct-to-consumer respiratory pathogen testing, we aimed to understand the epidemiological characteristics of bacterial co-detection among individuals with viral acute respiratory infection in the community.
Methods:
Individuals who self-initiated a direct-to-consumer multiplex respiratory pathogen testing service in seven municipalities of China between Nov 1, 2023, and Jan 31, 2025, were included. The primary outcome of interest was co-detection of Streptococcus pneumoniae or Haemophilus influenzae in those testing positive for any of the nine pathogens: influenza A virus (IAV), influenza B virus (IBV), SARS-CoV-2, human adenovirus (HAdV), Mycoplasma pneumoniae, human rhinovirus (HRV), respiratory syncytial virus (RSV), human parainfluenza virus (HPIV), and human coronavirus (HCoV). Both individual-level and population-level risks of bacterial co-detection with each of the nine pathogens were assessed, and subsequently synthesised with random-effects meta-analysis across regions by age group. We further identified clusters of clinical symptoms by the k-means approach and compared the spectrums of symptom clusters between mono-infection and bacterial co-detection groups for each of the nine pathogens.
Findings:
681 436 tests from 645 238 individuals (median age 28 years [IQR 7-38]; 56·0% female) were included in this study. The proportion of bacterial co-detection with S pneumoniae or H influenzae ranged from 75·7% in SARS-CoV-2 to 88·8% in HAdV. Risks of co-detection varied substantially by pathogen. Although increased risk of co-detection with S pneumoniae was observed for HAdV, HRV, IAV, IBV, M pneumoniae, and RSV, decreased risk was observed for SARS-CoV-2 among young children aged five years or younger. For co-detection with H influenzae, increased risk of co-detection was observed in those infected with HAdV, whereas decreased risk of co-detection was observed in those infected with IBV, RSV, and SARS-CoV-2. The risk of co-detection also varied by age group, with children having a higher risk of co-detection with S pneumoniae or H influenzae than adults. The k-means approach identified nine distinct symptom clusters. Different spectrums of symptom clusters were observed between those infected with and without a specific viral pathogen or M pneumoniae, regardless of the bacterial co-detection status. Symptom clusters were generally similar between mono-infection of each of the nine pathogens and co-detection with S pneumoniae or H influenzae, however, there were some exceptions for specific combinations of pathogens and age groups.
Interpretation:
Prevalence of bacterial co-detection among individuals infected with respiratory viruses or M pneumoniae is high, particularly among children, and varies by pathogen. Spectrums of clinical symptoms varies by pathogen and age groups, and can be different for the bacterial co-detection group and respective mono-infection group. These findings provide further insights into the possible interplay between viral and bacterial pathogens.
Funding:
National High Level Hospital Clinical Research Funding; National Natural Science Foundation of China, Noncommunicable Chronic Diseases - National Science and Technology Major Project; Beijing Nova Program.