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Therefore, we investigated the implications of viral and bacterial co-infection in COVID-19 clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nasopharyngeal samples were obtained from 48 COVID-19 patients (29% ICU and 71% non-ICU) and screened for the presence of 24 respiratory pathogens using six multiplex PCR panels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We found evidence of co-infection in 34 COVID-19 patients (71%). Influenza A H1N1 (n\u2009=\u200917),\n                      <jats:italic>Chlamydia pneumoniae<\/jats:italic>\n                      (n\u2009=\u200913) and human adenovirus (n\u2009=\u200910) were the most commonly detected pathogens. Viral co-infection was associated with increased ICU admission (r\u2009=\u20090.1) and higher mortality (OR 1.78, CI\u2009=\u20090.38\u20138.28) compared to bacterial co-infections (OR 0.44, CI\u2009=\u20090.08\u20132.45). Two thirds of COVID-19 critically ill patients who died, had a co-infection; and Influenza A H1N1 was the only pathogen for which a direct relationship with mortality was seen (r\u2009=\u20090.2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study highlights the importance of screening for co-infecting viruses in COVID-19 patients, that could be the leading cause of disease severity and death. Given the high prevalence of Influenza co-infection in our study, increased coverage of flu vaccination is encouraged to mitigate the transmission of influenza virus during the on-going COVID-19 pandemic and reduce the risk of severe outcome and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12985-021-01594-0","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T06:03:03Z","timestamp":1623650583000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":147,"title":["Influenza co-infection associated with severity and mortality in COVID-19 patients"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4719-2655","authenticated-orcid":false,"given":"Bandar","family":"Alosaimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Naeem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaweya E.","family":"Hamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitham S.","family":"Alkadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thamer","family":"Alanazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanaa Saad","family":"Al Rehily","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Z.","family":"Almutairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Zafar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,14]]},"reference":[{"key":"1594_CR1","unstructured":"WHO announces COVID-19 outbreak a pandemic. https:\/\/www.euro.who.int\/en\/health-topics\/health-emergencies\/coronavirus-covid-19\/news\/news\/2020\/3\/who-announces-covid-19-outbreak-a-pandemic . 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