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
Chorão, Pedro (Hospital Universitari i Politècnic La Fe (València))
Heras, Inmaculada (Hospital General Universitario Morales Meseguer (Múrcia))
Aiello, Francesco (Hospital Clínic i Provincial de Barcelona)
Garcia-Gutierrez, Valentín (Hospital Universitario Ramón y Cajal (Madrid))
Espigado, Ildefonso (Universidad de Sevilla)
González-Santillana, Clara (Hospital de Fuenlabrada (Madrid))
Hernández-Rivas, José Ángel (Hospital Universitario Infanta Leonor)
Roldán-Pérez, Alicia (Universidad Europea de Madrid)
Labrador, Jorge (Hospital Universitario de Burgos)
Vázquez, Lourdes (Hospital Universitario de Salamanca)
Martino Bofarull, Rodrigo (Institut de Recerca Sant Pau)
López-Jiménez, Javier (Hospital Universitario Ramón y Cajal (Madrid))
Cedillo Cedillo, Angel (Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH-TC) office (Madrid))
Solano, Carlos (Universitat de València)
García Cadenas, Irene (Institut de Recerca Sant Pau)
Piñana, José Luis (INCLIVA Institut d'Investigació Sanitària)
Avendaño, Alex (Hospital Universitario de Salamanca)
Mico-Cerdá, Mireia (INCLIVA Institut d'Investigació Sanitària)
Arrufat Bel, Ana (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Olave, Maria T. (Hospital Clínico Universitario "Lozano Blesa" de Zaragoza)
Acera Gómez, Marina (Hospital Universitario de Salamanca)
Cuesta-Casas, María Ángeles (Hospital Regional Universitario Carlos Haya (Málaga))
Villalba, Marta (Instituto de Investigación Sanitaria La Fe)
Garcia-Vidal, Carolina (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona. Departament de Medicina

Date:	2025
Abstract:	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 [HR] 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Co-infections ; Omicron ; SARS-CoV-2
Published in:	BMC Infectious diseases, Vol. 25, Num. 1 (December 2025) , p. 944, ISSN 1471-2334

DOI: 10.1186/s12879-025-11302-w
PMID: 40713537

13 p, 1.5 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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