High Prevalence of Respiratory Co-Infections and Risk Factors in COVID-19 Patients at Hospital Admission During an Epidemic Peak in China

Xiaoying Zhu,1,2 Fengqin Tian,2 Yulei Li,2 Qunfeng Lu,3 Qinqin Long,2 Xidai Long,1,2 Demin Cao2 1Medical College, Guangxi University, Nanning, Guangxi, People’s Republic of China; 2Clinical Pathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, People’s Republic of China; 3School of Medical Laboratory Sciences, Youjiang Medical University for Nationalities, Baise, Guangxi, People’s Republic of ChinaCorrespondence: Demin Cao; Xidai Long, Email caodm@ymun.edu.cn; sjtulongxd@ymun.edu.cnBackground: Recent research highlights the contribution of co-infections to elevated disease severity and mortality among COVID-19 patients. Given China’s decision to ease epidemic prevention policies in December 2022, a comprehensive exploration of the risks and characteristics of co-infections with respiratory pathogens becomes imperative.Methods: We conducted a retrospective analysis of 716 COVID-19 patients admitted to a primary hospital in China. The detection of twelve respiratory pathogens was conducted using qPCR, and the potential risk factors were analyzed through Cox regression analysis.Results: Within this cohort, 76.82% of cases exhibited co-infection involving eleven distinct pathogens. Among these, bacterial co-infections were observed in 74% of cases, with Streptococcus pneumoniae and Haemophilus influenzae emerging as the most prevalent bacterial co-infection agents. Additionally, 15% of cases presented with viral co-infections, predominantly involving influenza A virus and respiratory syncytial virus. Nevertheless, our investigation suggested that there might be some inappropriate antibiotic use in treatments. Furthermore, risk analysis unveiled dyspnea, hypoproteinemia, low lymphocyte counts, and co-infection with Mycoplasma pneumoniae as prominent risk factors for COVID-19 inpatients.Conclusion: Our findings underscore a significant occurrence of co-infections among COVID-19 patients during the epidemic, emphasizing the need for enhanced antibiotic stewardship. Effective management strategies should encompass respiratory status, nutritional aspects, and vigilance towards co-infections involving M. pneumoniae during COVID-19 treatment. This study underscores the significance of comprehensive management protocols to address the multifaceted challenges presented by co-infections in COVID-19 patients.Keywords: COVID-19, co-infection, respiratory pathogens, risk factors