整个大流行期间因COVID-19住院的成年患者中的细菌和病毒合并感染：EuCARE项目中的一项多国队列研究

Bacterial and Viral Coinfections in Adult Patients Hospitalized With COVID-19 Throughout the Pandemic: A Multinational Cohort Study in the EuCARE Project.

作者信息

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

机构信息

Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.

Department of Tropical Infectious Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Poland.

出版信息

J Infect Dis. 2025 Jul 11;231(6):e1091-e1101. doi: 10.1093/infdis/jiaf167.

DOI:10.1093/infdis/jiaf167

PMID:40176475

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12247819/

Abstract

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.

摘要

背景

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。

方法

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）。

结果

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）。