Background A mismatch between a widespread use of broad-spectrum antibiotic agents and a low prevalence of reported bacterial co-infections in patients with SARS-CoV-2 infections has been observed . Herein, we sought to characterize and compare bacterial co-infections at admission in hospitalized patients with SARS-CoV-2, influenza or respiratory syncytial virus (RSV) positive community-acquired pneumonia (CAP). Methods A retrospective cohort study of bacterial co-infections at admission in SARS-CoV-2, influenza or RSV-positive adult patients with CAP admitted to Karolinska University Hospital in Stockholm, Sweden, from year 2011 to 2020. The prevalence of bacterial co-infections was investigated and compared between the three virus groups. In each virus group, length of stay, ICU-admission and 30-day mortality was compared in patients with and without bacterial co-infection, adjusting for age, sex and co-morbidities. In the SARS-CoV-2 group, risk factors for bacterial co-infection, were assessed using logistic regression models and creation of two scoring systems based on disease severity, age, co-morbidities and inflammatory markers with assessment of concordance statistics. Results Compared to influenza and RSV, the bacterial co-infection testing frequency in SARS-CoV-2 was lower for all included test modalities. Four percent [46/1243 (95% CI 3–5)] of all SARS-CoV-2 patients had a bacterial co-infection at admission, whereas the proportion was 27% [209/775 (95% CI 24–30)] and 29% [69/242 (95% CI 23–35)] in influenza and RSV, respectively. S. pneumoniae and S. aureus constituted the most common bacterial findings for all three virus groups. Comparing SARS-CoV-2 positive patients with and without bacterial co-infection at admission, a relevant association could not be demonstrated nor excluded with regards to risk of ICU-admission (aHR 1.53, 95% CI 0.87–2.69) or 30-day mortality (aHR 1.28, 95% CI 0.66–2.46) in adjusted analyses. Bacterial co-infection was associated with increased inflammatory markers, but the diagnostic accuracy was not substantially different in a scoring system based on disease severity, age, co-morbidities and inflammatory parameters [C statistic 0.66 (95% CI 0.59–0.74)], compared to using disease severity, age and co-morbidities only [C statistic 0.63 (95% CI 0.56–0.70)]. Conclusions The prevalence of bacterial co-infections was significantly lower in patients with community-acquired SARS-CoV-2 positive pneumonia as compared to influenza and RSV positive pneumonia. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07089-9.
【저자키워드】 COVID-19, SARS-CoV-2, Influenza, respiratory syncytial virus, Co-infection, 【초록키워드】 Pneumonia, disease severity, Infection, diagnostic, inflammatory markers, Sex, risk, risk factor, virus, Prevalence, Concordance, Accuracy, RSV, Patient, co-morbidity, age, Inflammatory marker, Admission, bacterial co-infection, community-acquired pneumonia, co-morbidities, Bacterial, association, 30-Day mortality, antibiotic, Frequency, scoring system, retrospective cohort study, supplementary material, 95% CI, logistic regression model, positive, Karolinska University Hospital, significantly lower, adjusted analyses, widespread, Result, proportion, reported, investigated, hospitalized patient, demonstrated, groups, excluded, inflammatory parameter, patients with SARS-CoV-2, SARS-CoV-2 patient, SARS-CoV-2 positive patient, the SARS-CoV-2, were assessed, 【제목키워드】 Influenza virus, community-acquired pneumonia, caused,