Hedberg Pontus, Serwin Karol, Francesca Greco Maria, P V Pereira Joana, Juozapaite Dovile, De Benedittis Sara, Bai Francesca, Lübke Nadine, Wienemann Tobias, Fanti Iuri, König Florian, Pfeifer Nico, Kaiser Rolf, Zazzi Maurizio, Cozzi-Lepri Alessandro, Naumovas Daniel, Marchetti Giulia, Parczewski Milosz, Jensen Björn-Erik Ole, Incardona Francesca, Sönnerborg Anders, Nauclér Pontus
Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Tropical Infectious Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Poland.
J Infect Dis. 2025 Jul 11;231(6):e1091-e1101. doi: 10.1093/infdis/jiaf167.
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.
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).
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.
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.
自新冠病毒奥密克戎变异株出现以来，关于细菌和病毒合并感染如何演变的证据有限。我们调查了因新冠肺炎住院的成年患者中，社区获得性合并感染在野生型、阿尔法、德尔塔和奥密克戎时期是否存在差异，以及此类合并感染是否与死亡风险增加相关。
我们进行了一项多国队列研究，纳入了截至2023年4月30日在5个欧洲国家因新冠肺炎住院的患者。结局指标是基于5种检测方式的细菌和病毒合并感染情况。比较了不同变异株时期的合并感染发生率以及合并感染的风险比（奥密克戎与奥密克戎之前的变异株）, 以及与住院死亡率的关联（奥密克戎与奥密克戎之前的变异株）。
共纳入29564例病例：12601例野生型，5256例阿尔法，2433例德尔塔，9274例奥密克戎。野生型的合并感染率为2.6%（327/12601），阿尔法为2.0%（105/5256），德尔塔为3.2%（77/2433），奥密克戎为7.9%（737/9274）。与之前的变异株相比，奥密克戎的合并感染风险比显著增加（1.88[95%CI，1.53 - 2.32]，P <.001）。这些结果在多个亚组分析中是一致的。与未发生合并感染的患者相比，确诊合并感染的患者住院死亡率增加（19%[232/1246]对11%[3042/28318]），且校正风险增加（1.69[95%CI，1.49 - 1.91]，P <.001）。
与之前的变异株相比，奥密克戎时期细菌和病毒合并感染更为普遍。此类合并感染与住院死亡率增加相关，需要持续监测和临床警惕。
