Globale Prävalenz von ambulant erworbenen respiratorischen viralen Koinfektionen in COVID-19 Patienten und deren Auswirkung auf den Krankheitsverlauf: Systematischer Review und Metaanalyse
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Abstract
The emergence of SARS-CoV-2 and its spread across the world was declared as a global pandemic by the WHO in March 2020. Since then, numerous studies have been performed to investigate the disease COVID-19 as well as to develop therapeutic approaches. Prepandemic studies show, that co-infections in respiratory viral diseases can be one of the factors increasing the morbidity. While co-infections in COVID-19 patients have been described early on, the clinical relevance remains inconclusive. With SARS-CoV-2 becoming firmly established in the human population and the high incidence of other respiratory viral infections, it is important to evaluate the significance of co-infections. The aims of this systematic review and meta-analysis are to critically assess the published literature, determine the prevalence of respiratory viral infections in COVID-19 patients, identify the most common co-pathogens and describe the effects of co-infection on the course and outcome of disease.
We systematically searched PubMed, Web of Science, Embase, Scopus, and The Cochrane Library for studies published from 1 November 2019 to 13 August 2021. We included patients of all ages and any COVID-19 severity who were screened for respiratory viral co-infection within 48 hours of COVID-19 diagnosis according to WHO criteria. The main outcome was the proportion of patients with respiratory viral co infection according to the random-effects model. The prevalence analysis was carried out in different subgroups. The specific prevalence for each viral co-pathogen was determined. Secondary endpoints were defined to compare the mono- and co infected COVID-19 patients. The systematic review was prospective registered to PROSPERO.
Out of 6053 initially retrieved studies, 59 studies met the inclusion criteria. Among 16643 SARS-CoV-2 positive patients, 5.01% were coinfected with a second respiratory virus. Subgroup analyses showed that co-infection was significantly higher in paediatric (9.39%) than adult (3.51%) patients (p=0.02). Gender-specific subgroup analysis did not reveal any significant differences. Influenza viruses (1.54%) and enteroviruses (1.32%) were the most prevalent co-pathogens. Compared to mono-infected COVID-19 patients, the co-infected patients were more likely to be dyspnoeic (48.1% vs. 37.3%, OR=0.94) and the odds of fatality (OR=1.66) were increased. No significant differences were found with regard to the appearance of the symptoms cough and fever as well as the need of submission to an intensive care unit.
Although the incidence of COVID-19 remained high at the time of data collection, the rate of co-infections is relatively low. While the global implementation of non-pharmaceutical interventions reduced the circulation of respiratory viruses, seasonal patterns and the mechanisms of virus-virus-interaction influence the cocirculation and probability of co-infection of respiratory viruses. The results of this systematic review and meta-analysis suggest, that co-infection might have a negative impact in the course and outcome of disease. The use of multiplex PCR panels could be advisable regarding therapeutic and prognostic implications as well as infection control measures, especially for possible influenza virus or respiratory syncytial virus co infections. Given the methodological and clinical heterogeneity of the examined data, it is important to substantiate the results found in this systematic review and meta-analysis with further studies. The differentiation between certain age, risk and comorbidity subgroups as well as the separate investigation of co-pathogens considering the mechanisms of virus-virus-interaction and its effects on the COVID-19 patients should be of particular interest.
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Created: 2025Issued: 2025-08-06Updated: 2025-08-06
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Medizin
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Philipps-Universität Marburg
Language
ger
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DoctoralThesis
Keywords
Co-infectionMeta-analysis
DFG-subjects
COVID-19SARS-CoV-2KoinfektionSystematic ReviewMetaanalyse
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610
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Krumbein, Hanna: Globale Prävalenz von ambulant erworbenen respiratorischen viralen Koinfektionen in COVID-19 Patienten und deren Auswirkung auf den Krankheitsverlauf: Systematischer Review und Metaanalyse. : Philipps-Universität Marburg 2025-08-06. DOI: https://doi.org/10.17192/z2025.0401.
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