Trifonova Ivelina, Madzharova Iveta, Korsun Neli, Levterova Viktoria, Velikov Petar, Voleva Silvya, Ivanov Ivan, Ivanov Daniel, Yordanova Ralitsa, Tcherveniakova Tatiana, Angelova Svetla, Christova Iva
National Laboratory "Influenza and ARD", Department of Virology, National Centre of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria.
Infectious Disease Hospital "Prof. Ivan Kirov", Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria.
Biomedicines. 2024 Sep 27;12(10):2210. doi: 10.3390/biomedicines12102210.
Mixed infections can worsen disease symptoms. This study investigated the impact of mixed infections with viral and bacterial pathogens in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Using the in-house multiplex PCR method, we tested 337 SARS-CoV-2 positive samples for co-infections with three bacterial and 14 other viral pathogens.
Between August 2021 and May 2022, 8% of 337 SARS-CoV-2-positive patients had bacterial co-infections, 5.6% had viral co-infections, and 1.4% had triple mixed infections. The most common causes of mixed infections were (5.93%) and respiratory syncytial virus (RSV) (1.18%). Children < 5 years old had more frequent co-infections than adults < 65 years old (20.8% vs. 16.4%), while adults showed a more severe clinical picture with a higher C-reactive protein (CRP) level (78.1 vs.16.2 mg/L; = 0.033), a lower oxygen saturation (SpO2) (89.5 vs. 93.2%), and a longer hospital stay (8.1 vs. 3.1 days; = 0.025) (mean levels). The risk of a fatal outcome was 41% in unvaccinated patients ( = 0.713), which increased by 2.66% with co-infection with two pathogens ( = 0.342) and by 26% with three pathogens ( = 0.005). Additionally, 50% of intensive care unit (ICU) patients had a triple infection, compared with only 1.3% in the inpatient unit ( = 0.0029). The risk of death and/or ICU admission was 12 times higher ( = 0.042) with an additional pathogen and increased by 95% ( = 0.003) with a third concomitant pathogen.
Regular multiplex testing is important for prompt treatment and targeted antibiotic use.
混合感染会使疾病症状恶化。本研究调查了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测呈阳性的患者中病毒和细菌病原体混合感染的影响。
我们使用内部多重PCR方法，对337份SARS-CoV-2阳性样本进行检测，以确定是否同时感染三种细菌和其他14种病毒病原体。
在2021年8月至2022年5月期间，337例SARS-CoV-2阳性患者中，8%有细菌合并感染，5.6%有病毒合并感染，1.4%有三重混合感染。混合感染最常见的病原体是（5.93%）和呼吸道合胞病毒（RSV）（1.18%）。5岁以下儿童的合并感染比65岁以下成人更频繁（20.8%对16.4%），而成年人的临床症状更严重，C反应蛋白（CRP）水平更高（78.1对16.2mg/L；P=0.033），血氧饱和度（SpO2）更低（89.5%对93.2%），住院时间更长（8.1天对3.1天；P=0.025）（平均水平）。未接种疫苗患者的死亡风险为41%（P=0.713），两种病原体合并感染时增加2.66%（P=0.342），三种病原体合并感染时增加26%（P=0.005）。此外，重症监护病房（ICU）患者中有50%发生三重感染，而住院病房中仅为1.3%（P=0.0029）。额外感染一种病原体时，死亡和/或入住ICU的风险高12倍（P=0.042），同时感染第三种病原体时增加95%（P=0.003）。
定期进行多重检测对于及时治疗和针对性使用抗生素很重要。
