Bacterial and Viral Coinfections in Adult Patients Hospitalized With COVID-19 Throughout the Pandemic: A Multinational Cohort Study in the EuCARE Project - Report - MDSpire
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Bacterial and Viral Coinfections in Adult Patients Hospitalized With COVID-19 Throughout the Pandemic: A Multinational Cohort Study in the EuCARE Project
Coinfections in Adults Hospitalized for COVID-19: Increased Rates and Mortality During Omicron
Overview
This multinational cohort study of 29,564 adults hospitalized with COVID-19 found that bacterial and viral coinfections were significantly more prevalent during the Omicron period compared to earlier SARS-CoV-2 variants. Coinfections were associated with a substantially increased risk of in-hospital mortality.
Background
Bacterial community-onset coinfections in COVID-19 hospitalizations have historically been low, around 5%, despite high antibiotic use raising concerns about stewardship. The emergence of the Omicron variant has coincided with changes in respiratory virus circulation and possible increases in coinfection rates. Understanding variant-specific coinfection prevalence and their impact on COVID-19 severity is critical for guiding empirical antibiotic use and clinical management.
Data Highlights
Variant
Number of Cases
Coinfection Rate (%)
Wild type
12,601
2.6
Alpha
5,256
2.0
Delta
2,433
3.2
Omicron
9,274
7.9
Key Findings
The overall coinfection rate was significantly higher during the Omicron period (7.9%) compared to wild type (2.6%), Alpha (2.0%), and Delta (3.2%) periods.
Omicron infection was associated with an 88% increased risk of coinfection compared to pre-Omicron variants (risk ratio 1.88; 95% CI, 1.53–2.32; P < .001).
Patients with verified coinfections had a higher in-hospital mortality rate (19%) compared to those without coinfections (11%).
Adjusted analyses showed coinfections increased the risk of in-hospital mortality by 69% (adjusted risk 1.69; 95% CI, 1.49–1.91; P < .001).
Findings were consistent across multiple subgroup analyses and countries in the multinational cohort.
Clinical Implications
Clinicians should maintain heightened vigilance for bacterial and viral coinfections in patients hospitalized with COVID-19, especially during the Omicron period. The increased prevalence and associated mortality risk underscore the need for careful diagnostic evaluation and judicious antimicrobial stewardship to optimize patient outcomes. Ongoing monitoring of coinfection patterns is essential to inform empirical treatment guidelines.
Conclusion
Bacterial and viral coinfections have become more prevalent during the Omicron wave of COVID-19 and are linked to significantly increased in-hospital mortality. These findings highlight the importance of sustained clinical awareness and targeted management strategies for coinfections in hospitalized COVID-19 patients.
References
EuCARE Multinational Cohort Study 2023 -- Coinfections with Bacteria and Viruses in Adults Hospitalized for COVID-19 During the Pandemic
by Pontus Hedberg, Karol Serwin, Maria Francesca Greco, Joana P. V. Pereira, Dovile Juozapaite, Sara De Benedittis, Francesca Bai, Nadine Lübke, Tobias Wienemann, Iuri Fanti, Florian König, Nico Pfeifer, Rolf Kaiser, Maurizio Zazzi, Alessandro Cozzi-Lepri, Daniel Naumovas, Giulia Marchetti, Milosz Parczewski, Björn-Erik Ole Jensen, Francesca Incardona, Anders Sönnerborg, Pontus Nauclér
