{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T01:16:06Z","timestamp":1788225366995,"version":"build-2803163510"},"reference-count":29,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Project for National Health Commission Capacity Building and Continuing Education Center","award":["GWJJZX20251002015"],"award-info":[{"award-number":["GWJJZX20251002015"]}]},{"name":"Investigators-Initiated Studies Program of Merck Sharp & Dohme Corp Grant and Shanghai Municipal Science and Technology Major Project","award":["ZD2021CY001"],"award-info":[{"award-number":["ZD2021CY001"]}]},{"name":"Natioan Natural Science Foundation of China","award":["82504474"],"award-info":[{"award-number":["82504474"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>Respiratory syncytial virus (RSV) is a leading cause of acute respiratory tract infections (ARTI) in infants and young children. Co-infection with other respiratory pathogens is common in RSV infection. However, the associations of co-infection with disease severity and their potential interactions remain poorly understood, especially in light of evolving epidemiological patterns of respiratory pathogens following the COVID-19 pandemic. This multicenter, retrospective study included 2,862 children under 5 years of age and hospitalized with RSV at three pediatric centers in Wuhan, China, between June 2020 and May 2023. We evaluated the associations of co-infecting pathogens, including bacteria, viruses, fungi, and atypical bacteria, with disease severity, length of hospital stay, and inpatient medical expenses. We found that nearly 44% of children with RSV were co-infected with at least one additional pathogen. Co-infection rates fluctuated in correlation with the implementation and relaxation of COVID-19 non-pharmaceutical interventions. While viral and atypical bacterial co-infections did not significantly alter outcomes, bacterial (OR = 2.00, 95% CI: 1.48, 2.70) and fungal (OR = 2.57, 95% CI: 1.23, 5.35) co-infections were strongly associated with increased disease severity. Both types were also linked to longer hospital stays (days, \u03b2 = 0.63, 95% CI: 0.38, 0.88 for bacterial; \u03b2 = 2.68, 95% CI: 1.94, 3.43 for fungal) and higher inpatient medical expenses (Chinese Yuan [CNY], \u03b2 = 2,317.16, 95% CI: 1,534.43, 3,099.88 for bacterial; \u03b2 = 6,636.55, 95% CI: 4,366, 8,907.10 for fungal). No significant additive interactions were found between bacterial and fungal co-infections. These findings highlight the importance of distinguishing co-infection types in the clinical management of RSV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>This study clarifies the clinical significance of pathogen co-infections in children hospitalized with respiratory syncytial virus (RSV). We demonstrate a critical distinction that co-infections with bacteria or fungi are associated with more severe disease, longer hospitalizations, and higher costs, whereas viral or atypical bacterial co-infections are not. In the context of evolving RSV epidemiology and pathogen co-infections in the post-pandemic era, this finding may help risk-based clinical management when co-infection exists.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00945-26","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:02:02Z","timestamp":1781528522000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Differential associations of pathogen-specific co-infections with disease severity in pediatric RSV hospitalizations: a 3-year multicenter analysis"],"prefix":"10.1128","volume":"14","author":[{"given":"Dong","family":"Xu","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00p991c53","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, 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[Guidelines for management of community acquired pneumonia in children(the revised edition of 2013) (II)]. 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