Bacterial and Viral Respiratory Co-infections With SARS-CoV-۲ in Deceased Patients of North Khorasan, Iran, During ۲۰۲۰-۲۰۲۳

Introduction: Co-infections play a significant role in exacerbating COVID-۱۹ complications, especially among hospitalized patients. Many respiratory bacteria and viruses can cause co-infection or superinfections. Methods: We evaluated bacterial and viral co-infections in ۴۸۰ samples from deceased patients and ۴۸۰ randomly selected samples from surviving SARS-CoV-۲-positive patients. Samples were tested for respiratory bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Mycoplasma pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus, as well as important respiratory viral pathogens, including influenza virus, human metapneumovirus, parainfluenza virus (A–D), adenovirus, respiratory syncytial virus (RSV), and bocavirus using polymerase chain reaction (PCR) and reverse transcription PCR (RT-PCR) assays. Results: We evaluated ۸۸۴۶ samples for SARS-CoV-۲ from May ۱, ۲۰۲۰ to March ۲۱, ۲۰۲۳. Of these, ۲۹۱۹ (۳۳%) were SARS-CoV-۲ positive, and ۵۹۲۷ (۶۷%) had negative RT-PCR results. Four hundred eighty cases (۱۶.۴۴%) of positive patients died. A. baumannii was the most prevalent bacterium in deceased patients compared with surviving patients (P=۰.۰۴۳), and S. pneumoniae was the most abundant in surviving patients (P=۰.۰۶۲). Influenza A virus was the most common virus in both groups (P<۰.۰۰۱). The most common underlying conditions in deceased patients were diabetes and asthma (P<۰.۰۵), while in the surviving patients they were obesity and hypertension (P=۰.۰۷۱). Most coinfected patients were older than ۶۰ years. Conclusion: This study highlights the significant impact of bacterial and viral coinfections on the clinical course and outcomes of SARS-CoV-۲ infection. We recommend active screening for co-infections upon hospital admission, promotion of influenza vaccination, and strengthening of hospital infection-control measures, especially against multidrug-resistant organisms such as A. baumannii.