ArticleEClinicalMedicine2021
Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients.
Article in EClinicalMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 81 papers, 2 of them syntheses that pooled it.
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Who cites it
81 citing papers in PubMed, 2 syntheses or guidelines pooled it, 119 citations in OpenAlex.
- Effect of Pneumococcal Conjugate Vaccines on Viral Respiratory Infections: A Systematic Literature Review.The Journal of infectious diseases · 2024Pooled it
- Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019-June 2021).Antimicrobial resistance and infection control · 2022Pooled it
- Prevalence and Outcomes of Bacterial Co-detections by Blood Culture Among Children and Adults Hospitalized With Laboratory-confirmed Influenza, Influenza Hospitalization Surveillance Network, 2022-2024.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Factors influencing antibiotic use in confirmed viral respiratory tract infections.The Journal of antimicrobial chemotherapy · 2026Observational
- Antibiotic Use, Bacterial Co-Infection, and Antimicrobial Resistance in Adults Hospitalized with COVID-19, Influenza, or RSV: A Systematic Review and Meta-Analysis.Antibiotics (Basel, Switzerland) · 2026Review
- Challenges and opportunities in the management of severe pneumonia. Key concepts from the Seventh Annual Meeting of Spanish Experts 2025.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- One Sample, Many Insights: The Epidemiological and Public Health Value of Multiplex PCR Respiratory Panels Following the End of the COVID-19 Pandemic.Microorganisms · 2026Article
- Article
- Clinical Characteristics and Severity of Rhinovirus/Enterovirus-Associated Hospitalizations: A Multicountry Analysis From the Global Influenza Hospital Surveillance Network, 2017-2024.Open forum infectious diseases · 2026Article
- Metagenomic sequencing identifies potential respiratory pathogens in PCR-negative subset of surveillance samples.Scientific reports · 2026Article
- Prevalence of respiratory viruses and nasal colonization by antimicrobial-resistant bacteria among people living with HIV in Ghana.BMC infectious diseases · 2026Article
- Article
- Segmented filamentous bacteria reprogramming of alveolar macrophages limits postinfluenza bacterial pneumonia.Science immunology · 2026Article
- Therapeutic effect of ginseng: a non-antibiotic approach to preventing pathogenic bacterial infections and restoring gut microbiota composition.Frontiers in pharmacology · 2026Review
- SARS-CoV-2-International journal of microbiology · 2026Review
- Current insights into bacterial secondary infection following influenza A virus infection.Frontiers in microbiology · 2026Review
- Case Report: High-altitude exposure and severe respiratory infection precipitating diabetic ketoacidosis: new-onset ketosis-prone diabetes unmasked by physiological stress.Frontiers in medicine · 2026Article
- Hidden burden of pneumococcal colonization in adults with viral respiratory infections: the role of influenza and RSV.Frontiers in cellular and infection microbiology · 2026Article
- Outcomes Related to Bacterial Co-Infection and Antibiotic Use in Adults Hospitalized With Respiratory Syncytial Virus Compared with Influenza.Open forum infectious diseases · 2026Article
- Epidemiological characteristics of bacterial lower respiratory tract infections in Jingzhou, Central China, 2020-2024.Frontiers in cellular and infection microbiology · 2026Article
21 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
24 authors at 6 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundViral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections.
methodsWe included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates.
findingsAmong 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species,
interpretationIn our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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