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
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 r...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12879-025-11302-w |
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| author | Pedro Chorão Alex Avendaño Inmaculada Heras Francesco Aiello Mireia Micó-Cerdá Ana Arrufat Bel Valentín Garcia-Gutierrez María T. Olave Marina Acera Gómez Ildefonso Espigado María Ángeles Cuesta-Casas Clara González-Santillana José Ángel Hernández-Rivas Alicia Roldán-Pérez Jorge Labrador Marta Villalba Lourdes Vázquez Carolina Garcia Vidal Rodrigo Martino Javier López-Jiménez Ángel Cedillo Carlos Solano Irene García-Cadenas José Luís Piñana on behalf of the Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Group (GETH-TC) |
| author_facet | Pedro Chorão Alex Avendaño Inmaculada Heras Francesco Aiello Mireia Micó-Cerdá Ana Arrufat Bel Valentín Garcia-Gutierrez María T. Olave Marina Acera Gómez Ildefonso Espigado María Ángeles Cuesta-Casas Clara González-Santillana José Ángel Hernández-Rivas Alicia Roldán-Pérez Jorge Labrador Marta Villalba Lourdes Vázquez Carolina Garcia Vidal Rodrigo Martino Javier López-Jiménez Ángel Cedillo Carlos Solano Irene García-Cadenas José Luís Piñana on behalf of the Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Group (GETH-TC) |
| author_sort | Pedro Chorão |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-385ddbdc17944e379430c49cee776cda |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-385ddbdc17944e379430c49cee776cda2025-08-20T03:45:47ZengBMCBMC Infectious Diseases1471-23342025-07-0125111310.1186/s12879-025-11302-wCo-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 studyPedro Chorão0Alex Avendaño1Inmaculada Heras2Francesco Aiello3Mireia Micó-Cerdá4Ana Arrufat Bel5Valentín Garcia-Gutierrez6María T. Olave7Marina Acera Gómez8Ildefonso Espigado9María Ángeles Cuesta-Casas10Clara González-Santillana11José Ángel Hernández-Rivas12Alicia Roldán-Pérez13Jorge Labrador14Marta Villalba15Lourdes Vázquez16Carolina Garcia Vidal17Rodrigo Martino18Javier López-Jiménez19Ángel Cedillo20Carlos Solano21Irene García-Cadenas22José Luís Piñana23on behalf of the Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Group (GETH-TC)Hematology Department, Hospital Universitari I Politècnic La FeHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC)Hematology Division, Hospital Morales MeseguerInfectious Disease Division, Hospital ClinicHematology Department, Hospital Clínico Universitario de ValenciaHematology Division, Hospital de La Santa Creu I Sant PauHematology Division, Hospital Ramon y CajalHematology Division, Hospital Clínico Universitario Lozano Blesa, IIS AragonHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC)Hematology Division, Hospital Universitario Virgen Macarena– Hospital Universitario Virgen del Rocío, IBiS-CSIC, Universidad de SevillaHematology Division, Hospital Regional Universitario Carlos HayaHematology Division, Hospital de FuenlabradaHematology Division, Hospital Universitario Infanta LeonorHematology Division, Hospital Universitario Infanta SofiaResearch Unit, Hospital Universitario de BurgosHematology Department, Hospital Universitari I Politècnic La FeHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC)Infectious Disease Division, Hospital ClinicHematology Division, Hospital de La Santa Creu I Sant PauHematology Division, Hospital Ramon y CajalHematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH-TC) OfficeHematology Department, Hospital Clínico Universitario de ValenciaHematology Division, Hospital de La Santa Creu I Sant PauHematology Department, Hospital Clínico Universitario de ValenciaAbstract 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.https://doi.org/10.1186/s12879-025-11302-wSARS-CoV-2OmicronCo-infections |
| spellingShingle | Pedro Chorão Alex Avendaño Inmaculada Heras Francesco Aiello Mireia Micó-Cerdá Ana Arrufat Bel Valentín Garcia-Gutierrez María T. Olave Marina Acera Gómez Ildefonso Espigado María Ángeles Cuesta-Casas Clara González-Santillana José Ángel Hernández-Rivas Alicia Roldán-Pérez Jorge Labrador Marta Villalba Lourdes Vázquez Carolina Garcia Vidal Rodrigo Martino Javier López-Jiménez Ángel Cedillo Carlos Solano Irene García-Cadenas José Luís Piñana on behalf of the Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation Cell Therapy Group (GETH-TC) 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 BMC Infectious Diseases SARS-CoV-2 Omicron Co-infections |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | SARS-CoV-2 Omicron Co-infections |
| url | https://doi.org/10.1186/s12879-025-11302-w |
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