tetano
Editor, Senior Moderator
BMC Infect Dis
. 2025 Jul 25;25(1):944.
doi: 10.1186/s12879-025-11302-w. Co-infections during SARS-CoV-2 infection in hematologic patients and cell therapy recipients in the omicron era: a Spanish hematopoietic stem cell transplantation and cell therapy group study
Pedro Chorão[SUP] 1 2 [/SUP], Alex Avendaño[SUP] 3 [/SUP], Inmaculada Heras[SUP] 4 [/SUP], Francesco Aiello[SUP] 5 [/SUP], Mireia Micó-Cerdá[SUP] 6 7 [/SUP], Ana Arrufat Bel[SUP] 8 [/SUP], Valentín Garcia-Gutierrez[SUP] 9 [/SUP], María T Olave[SUP] 10 [/SUP], Marina Acera Gómez[SUP] 3 [/SUP], Ildefonso Espigado[SUP] 11 [/SUP], María Ángeles Cuesta-Casas[SUP] 12 [/SUP], Clara González-Santillana[SUP] 13 [/SUP], José Ángel Hernández-Rivas[SUP] 14 [/SUP], Alicia Roldán-Pérez[SUP] 15 16 [/SUP], Jorge Labrador[SUP] 17 18 [/SUP], Marta Villalba[SUP] 19 20 [/SUP], Lourdes Vázquez[SUP] 3 [/SUP], Carolina Garcia Vidal[SUP] 5 [/SUP], Rodrigo Martino[SUP] 8 [/SUP], Javier López-Jiménez[SUP] 9 [/SUP], Ángel Cedillo[SUP] 21 [/SUP], Carlos Solano[SUP] 6 7 22 [/SUP], Irene García-Cadenas[SUP] 8 [/SUP], José Luís Piñana[SUP] 6 7 [/SUP]; Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Group (GETH-TC)
Affiliations
Background: Although SARS-Cov-2 outcomes have improved in the Omicron era, the synergistic or additive effects between SARS-CoV-2 Omicron variants and other microbiological agents in adult hematologic patients have been little explored. We aimed to characterize co-infection types, identify risk factors for co-infection and determine co-infection-related mortality in hematologic patients and recipients of cellular therapy with a first episode of SARS-CoV-2 infection in the Omicron era.
Methods: Retrospective national Spanish registry analysis of 692 consecutive patients with hematological disease including receptors of cellular therapy from December 2021 to May 2023.
Results: The co-infection rate was 9% (n = 64), 30% of which were polymicrobial. Bacterial, viral, and fungal agents affected 64%, 30%, and 11% of patients, respectively. Among the microbiologically confirmed agents (n = 82), the most common sites of identification were lower respiratory tract (33%), urinary tract (27%) and bloodstream (17%). Multivariable analysis identified cardiopathy (hazard ratio
1.69), CAR-T therapy (HR 3.42) and pneumonia (HR 5.54) as conditions associated with co-infection. Considering all-cause mortality at day 180 after SARS-CoV-2 detection, co-infection was associated with lower survival (71% versus 92%). Risk factors at COVID-19 diagnosis for non-relapse mortality (NRM) were co-infection (HR 4.28), age ≥ 64 years old (HR 2.55), active hematological treatment (HR 2.13) and under corticosteroid treatment (HR 3.21). In co-infected patients, the only identified factor increasing NRM was corticosteroid use (HR 3.33) at the time of SARS-CoV-2 detection.
Conclusions: SARS-CoV-2 co-infection are relatively frequent in hematologic patients and cellular therapy recipients in the Omicron era. Patients with ischemic cardiopathy, those presenting with pneumonia and recipients of CAR-T are at a higher risk of developing a co-infection, while co-infection, age ≥ 64 years old, active hematological therapy and corticosteroid treatment showed higher NRM. Improvements in identifying and managing concurrent infections during SARS-CoV-2 are needed to further reduce morbimortality in hematologic patients.
Keywords: Co-infections; Omicron; SARS-CoV-2.
. 2025 Jul 25;25(1):944.
doi: 10.1186/s12879-025-11302-w. Co-infections during SARS-CoV-2 infection in hematologic patients and cell therapy recipients in the omicron era: a Spanish hematopoietic stem cell transplantation and cell therapy group study
Pedro Chorão[SUP] 1 2 [/SUP], Alex Avendaño[SUP] 3 [/SUP], Inmaculada Heras[SUP] 4 [/SUP], Francesco Aiello[SUP] 5 [/SUP], Mireia Micó-Cerdá[SUP] 6 7 [/SUP], Ana Arrufat Bel[SUP] 8 [/SUP], Valentín Garcia-Gutierrez[SUP] 9 [/SUP], María T Olave[SUP] 10 [/SUP], Marina Acera Gómez[SUP] 3 [/SUP], Ildefonso Espigado[SUP] 11 [/SUP], María Ángeles Cuesta-Casas[SUP] 12 [/SUP], Clara González-Santillana[SUP] 13 [/SUP], José Ángel Hernández-Rivas[SUP] 14 [/SUP], Alicia Roldán-Pérez[SUP] 15 16 [/SUP], Jorge Labrador[SUP] 17 18 [/SUP], Marta Villalba[SUP] 19 20 [/SUP], Lourdes Vázquez[SUP] 3 [/SUP], Carolina Garcia Vidal[SUP] 5 [/SUP], Rodrigo Martino[SUP] 8 [/SUP], Javier López-Jiménez[SUP] 9 [/SUP], Ángel Cedillo[SUP] 21 [/SUP], Carlos Solano[SUP] 6 7 22 [/SUP], Irene García-Cadenas[SUP] 8 [/SUP], José Luís Piñana[SUP] 6 7 [/SUP]; Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Group (GETH-TC)
Affiliations
- PMID: 40713537
- DOI: 10.1186/s12879-025-11302-w
Background: Although SARS-Cov-2 outcomes have improved in the Omicron era, the synergistic or additive effects between SARS-CoV-2 Omicron variants and other microbiological agents in adult hematologic patients have been little explored. We aimed to characterize co-infection types, identify risk factors for co-infection and determine co-infection-related mortality in hematologic patients and recipients of cellular therapy with a first episode of SARS-CoV-2 infection in the Omicron era.
Methods: Retrospective national Spanish registry analysis of 692 consecutive patients with hematological disease including receptors of cellular therapy from December 2021 to May 2023.
Results: The co-infection rate was 9% (n = 64), 30% of which were polymicrobial. Bacterial, viral, and fungal agents affected 64%, 30%, and 11% of patients, respectively. Among the microbiologically confirmed agents (n = 82), the most common sites of identification were lower respiratory tract (33%), urinary tract (27%) and bloodstream (17%). Multivariable analysis identified cardiopathy (hazard ratio
1.69), CAR-T therapy (HR 3.42) and pneumonia (HR 5.54) as conditions associated with co-infection. Considering all-cause mortality at day 180 after SARS-CoV-2 detection, co-infection was associated with lower survival (71% versus 92%). Risk factors at COVID-19 diagnosis for non-relapse mortality (NRM) were co-infection (HR 4.28), age ≥ 64 years old (HR 2.55), active hematological treatment (HR 2.13) and under corticosteroid treatment (HR 3.21). In co-infected patients, the only identified factor increasing NRM was corticosteroid use (HR 3.33) at the time of SARS-CoV-2 detection.
Conclusions: SARS-CoV-2 co-infection are relatively frequent in hematologic patients and cellular therapy recipients in the Omicron era. Patients with ischemic cardiopathy, those presenting with pneumonia and recipients of CAR-T are at a higher risk of developing a co-infection, while co-infection, age ≥ 64 years old, active hematological therapy and corticosteroid treatment showed higher NRM. Improvements in identifying and managing concurrent infections during SARS-CoV-2 are needed to further reduce morbimortality in hematologic patients.
Keywords: Co-infections; Omicron; SARS-CoV-2.