ArticleBMC microbiology2026
Risk factors and outcomes of secondary co-infections in hospitalised COVID-19 patients in Malaysia: a case control study.
Article in BMC microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHospitalised COVID-19 patients are susceptible to co-infections. This study aims to evaluate the risk factors and outcomes of secondary co-infections in hospitalised COVID-19 patients in Malaysia. A total of 929 COVID-19 patients were admitted to our centre from January 2021 to December 2022. Thirty-four cases of secondary co-infections among hospitalised COVID-19 patients were identified using standard microbiology culture. A control group of 136 hospitalised COVID-19 patients without secondary infections, admitted during the same period, was randomly selected. Additionally, 48 archived COVID-19 samples were analysed for primary co-infections involving 33 respiratory pathogens using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR).
resultsThe prevalence of secondary co-infections in hospitalised COVID-19 patients was 3.7%. Thirty-nine pathogens were isolated where Acinetobacter baumannii and Candida spp. were among the commonest isolated pathogens (4 isolates each, 10.3%). Significant factors associated with secondary co-infections included longer hospital stay (p ≤ 0.001) and hypertension (p = 0.032). Laboratory findings associated with secondary co-infections were thrombocytopenia (p = 0.021) and elevated alkaline phosphatase (p = 0.024). Among patients with secondary co-infections, 52.9% died, compared to only 14.7% in the control group (p = 0.008), highlighting the poor clinical outcomes of patients with co-infections. Secondary co-infections were also significantly associated with ICU admission (p = 0.045). Out of 48 archived samples, 32 samples (66.7%) were found to have positive respiratory pathogens of primary co-infection.
conclusionAlthough secondary co-infections occurred in a relatively small subset of hospitalised COVID-19 patients, their profound association with fatal outcomes underscores the need for heightened clinical vigilance when these specific risk factors are present.
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