Bacterial and Viral Co-Infections in COVID-19 Patients: Etiology and Clinical Impact
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population Survey and Sampling
2.2. Detection of Respiratory Co-Pathogens
2.2.1. Extraction
2.2.2. Detection of Bacterial Co-Pathogens
2.2.3. Detection of Viral Co-Pathogens
- (1)
- AdV, RSV, and PIV1;
- (2)
- BoV, RV, and PIV2;
- (3)
- HMPV and PIV3;
- (4)
- HCoV-229E and HCoV-HKU-1;
- (5)
- HCoV-NL63 and HCoV-OC43;
- (6)
- SARS-CoV-2 and influenza A and B viruses (FluSC2).
- Reverse transcription: 25 °C for 2 min and then 50 °C for 15 min;
- Initial denaturation: 95 °C for 2 min;
- Amplification for 45 cycles: 95 °C for 15 s and then 55 °C for 30 s.
2.3. Next-Generation Sequencing (NGS)
2.4. Definitions and Data
2.5. Statistical Analysis
3. Results
3.1. Population Characteristics
3.2. Detection of Co-Infections in COVID-19 Patients
3.3. Viral Load of Respiratory Virus Co-Infections
3.4. Distribution of SARS-CoV-2 Variants in Individual Proven Co-Infections
3.5. Weekly and Seasonal Distribution of Confirmed Co-Infections
3.6. Clinical Data of the Investigated Patients
3.7. Age Characteristics of the Clinical Presentation of Respiratory Infection in Mono- and Co-Infected Patients
3.8. Vaccination Status
3.9. Determining the Clinical Severity of COVID-19 in Mono- and Co-Infections with Bacterial and Viral Co-Pathogens: Treatment
3.10. Treatment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Co-Infection | n | % |
---|---|---|
SARS-CoV-2 + HI | 20 | 47.62% |
SARS-CoV-2 + RSV | 4 | 9.52% |
SARS-CoV-2 + ChP | 3 | 7.14% |
SARS-CoV-2 + AdV | 3 | 7.14% |
SARS-CoV-2 + HI + RSV | 3 | 7.14% |
SARS-CoV-2 + BoV | 2 | 4.76% |
SARS-CoV-2 + RV | 1 | 2.38% |
SARS-CoV-2 + HMPV | 1 | 2.38% |
SARS-CoV-2 + PIV3 | 1 | 2.38% |
SARS-CoV-2 + HKU-1 | 1 | 2.38% |
SARS-CoV-2 + NL63 | 1 | 2.38% |
SARS-CoV-2 + HI + AdV | 1 | 2.38% |
SARS-CoV-2 + HI + PIV2 | 1 | 2.38% |
SARS-CoV-2 + MP | 0 | 0% |
SARS-CoV-2 + PIV1 | 0 | 0% |
SARS-CoV-2 + PIV2 | 0 | 0% |
SARS-CoV-2 + 229E | 0 | 0% |
SARS-CoV-2 + OC43 | 0 | 0% |
SARS-CoV-2 + Influenza A | 0 | 0% |
SARS-CoV-2 + Influenza B | 0 | 0% |
Delta | ||
---|---|---|
Tested: 119 | ||
Co-infections: 2 | ||
Positive rate: 1.7% | ||
AY.75.1 | + BoV | n = 1 |
AY.4.4 | + RSV | n = 1 |
Omicron | ||
Tested: 186 | ||
Co-infections: 32 (29 + 3 triple) | ||
Positive rate: 17.2% | ||
BA.1 | + AdV | n = 1 |
+ RSV | n = 1 | |
BA.1.1 | + HI | n = 2 |
BA.2 | + HI | n = 13 |
+ HI + RSV | n = 1 | |
+ HI +PIV2 | n = 1 | |
+ HI + AdV | n = 1 | |
+ ChP | n = 2 | |
+ RSV | n = 1 | |
+ BoV | n = 1 | |
+ PIV3 | n = 1 | |
+ NL63 | n = 1 | |
+ AdV | n = 2 | |
BA.2.12 | + RV | n = 1 |
BA.2.9 | + HI | n = 2 |
+ ChP | n = 1 |
Age Group (Years Old) | 0–5 | 6–16 | 17–64 | >65 |
---|---|---|---|---|
Co-infected * (n) | 5 | 2 | 7 | 17 |
Symptom | ||||
Fever, n (%) | 4 (80) | 1 (50) | 7 (100) | 13 (76.5) |
Fatigue, n (%) | 4 (80) | 2 (100) | 7 (100) | 11 (64.7) |
Cough, n (%) | 2 (40) | 0 (0) | 7 (100) | 14 (82.4) |
Diarrhea, n (%) | 1 (20) | 1 (50) | 2 (28.6) | 0 (0) |
Headache, n (%) | 0 (0) | 0 (0) | 0 (0) | 3 (17.6) |
Rhinitis, n (%) | 3 (60) | 1 (50) | 2 (28.6) | 4 (23.5) |
Pneumonia, n (%) | 2 (40) | 2 (100) | 5 (71.4) | 15 (88.2) |
Laboratory results | ||||
Oxygen saturation, mean % | 93.2 | 90.5 | 91.7 | 89.5 |
Lym **,mean × 109/L | 2.73 | 2.1 | 2.1 | 2.3 |
WBC **, mean × 109/L | 5.1 | 9.7 | 4.9 | 5.4 |
CRP **, mean mg/L | 16.2 | 56 | 42.9 | 78.1 |
Hospital stay, mean/SD ** (days) | 3.1/2.2 | 6/5.6 | 5.2/2.3 | 8.1/3.7 |
Hospital stay, median (days) | 3 | 6 | 6 | 9 |
Clinical outcome | ||||
ICU ** stay, n (%) | 1 (20) | 0 (0) | 1 (14.3) | 1 (20) |
Fatal outcome, n (%) | 0 | 0 | 1 (14.3) | 2 (11.8) |
SARS-CoV-2 Mono-Infection | Viral SARS-CoV-2 Co-Infection | Bacterial SARS-CoV-2 Co-Infection | SARS-CoV-2 Triple Infection | p-Value: Viral vs. Bacterial Co-Infection | p-Value: Co- vs. Triple Infection | p-Value: Mono- vs. Co-Infection | p-Value: Mono- vs. Triple Infection | |
---|---|---|---|---|---|---|---|---|
Distribution, n (%) | 295 (87.5) | 14 (4.2) | 23 (6.8) | 5 (1.5) | – | – | – | – |
With clinical data, n | 141 | 9 | 19 | 5 | – | – | – | – |
Symptoms, n (%) | ||||||||
Fever | 110 (78) | 8 (88.9) | 15 (78.9) | 4 (80) | 1 | 1 | 0.8138 | 1 |
Fatigue | 111 (78.8) | 7 (77.8) | 14 (73.7) | 4 (80) | 1 | 1 | 0.8151 | 1 |
Cough | 107 (75.9) | 7 (77.8) | 14 (73.7) | 3 (60) | 1 | 0.5971 | 0.8228 | 0.5971 |
Diarrhea | 22 (15.6) | 1 (11.7) | 2 (10.5) | 2 (40) | 1 | 0.1546 | 1 | 0.1895 |
Headache | 39 (27.7) | 4 (44.4) | 1 (5.3) | – | 0.0256 | 0.5686 | 0.1825 | 0.3247 |
Rhinitis | 50 (35.5) | 3 (33.3) | 4 (21.1) | 2 (40) | 0.6465 | 0.5971 | 0.4198 | 1 |
Pneumonia | 83 (58.9) | 6 (66.7) | 12 (63.2) | 3 (60) | 1 | 1 | 0.6955 | 1 |
Laboratory results, mean | ||||||||
Oxygen saturation (%) | 91.8 | 93.4 | 90.4 | 87.8 | n.s * | n.s | n.s | n.s |
Lym **, (×109/L) | 1.76 | 0.88 | 3.1 | 1.5 | n.s | n.s | n.s | n.s |
WBC **, (×109/L) | 6.9 | 5.4 | 5.4 | 8.7 | n.s | 0.02 | n.s | n.s |
CRP **, (mg/L) | 65.5 | 86.7 | 48.3 | 109.6 | n.s | n.s | n.s | n.s |
Treatment, n (%) | ||||||||
Antibiotics | 96 (68.1) | 7 (77.8) | 12 (63.2) | 4 (80) | 0.67 | 1 | 1 | 1 |
Antiviral drugs | 14 (9.9) | – | 1 (5.3) | – | 1 | 1 | 0.3086 | 1 |
Corticosteroids | 44 (31.2) | 3 (33.3) | 9 (47.4) | 3 (60) | 0.687 | 0.639 | 0.1525 | 0.3283 |
Vasodilators | 10 (7.1) | – | 1 (5.3) | – | 1 | 1 | 0.6925 | 1 |
Heparin | 73 (51.8) | 6 (66.7) | 11 (57.9) | 2 (40) | 1 | 0.6285 | 0.5658 | 0.3595 |
Oxygen therapy | 60 (42.6) | 3 (33.3) | 10 (52.3) | 4 (80) | 0.4348 | 0.3353 | 0.4367 | 0.1687 |
Clinical outcome | ||||||||
Hospital stay, mean/SD ** (days) | 6.1/4.2 | 7.8/3.4 | 5.3/3.3 | 6.3/2.4 | n.s | n.s | n.s | n.s |
Hospital stay, median (days) | 5 | 8 | 4 | 7 | ||||
ICU ** stay, n (%) | 1 (0.7) | – | 1 (5.3) | 2 (40) | 1 | 0.0501 | 0.3129 | 0.0028 |
Fatal outcome, n (%) | 14 (9.9) | – | 2 (10.5) | 1 (20) | 1 | 0.3996 | 1 | 0.4493 |
Factor | Coefficients | Lower 95% CI | Upper 95% CI | Std. Error | z | p | Exp(B) | Lower 95% CI | Upper 95% CI |
---|---|---|---|---|---|---|---|---|---|
Co-infection with two viruses | 2.5 | 0.09 | 4.9 | 1.23 | 2.04 | 0.042 | 12.14 | 1.1 | 134.26 |
Co-infection with three viruses | 4.55 | 1.51 | 7.58 | 1.55 | 2.94 | 0.003 | 94.5 | 4.54 | 1967.29 |
Days from the onset of symptoms before hospitalization | 0.25 | -0.08 | 0.58 | 0.17 | 1.51 | 0.131 | 1.29 | 0.93 | 1.79 |
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Trifonova, I.; Madzharova, I.; Korsun, N.; Levterova, V.; Velikov, P.; Voleva, S.; Ivanov, I.; Ivanov, D.; Yordanova, R.; Tcherveniakova, T.; et al. Bacterial and Viral Co-Infections in COVID-19 Patients: Etiology and Clinical Impact. Biomedicines 2024, 12, 2210. https://doi.org/10.3390/biomedicines12102210
Trifonova I, Madzharova I, Korsun N, Levterova V, Velikov P, Voleva S, Ivanov I, Ivanov D, Yordanova R, Tcherveniakova T, et al. Bacterial and Viral Co-Infections in COVID-19 Patients: Etiology and Clinical Impact. Biomedicines. 2024; 12(10):2210. https://doi.org/10.3390/biomedicines12102210
Chicago/Turabian StyleTrifonova, Ivelina, Iveta Madzharova, Neli Korsun, Viktoria Levterova, Petar Velikov, Silvya Voleva, Ivan Ivanov, Daniel Ivanov, Ralitsa Yordanova, Tatiana Tcherveniakova, and et al. 2024. "Bacterial and Viral Co-Infections in COVID-19 Patients: Etiology and Clinical Impact" Biomedicines 12, no. 10: 2210. https://doi.org/10.3390/biomedicines12102210