{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:11:48Z","timestamp":1787026308949,"version":"build-2736575974"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The study aimed to clarify the co-infection patterns in adult patients with severe influenza A (H1N1) pneumonia using Metagenomic Next-Generation Sequencing (mNGS) and to examine their impact on clinical outcomes, particularly focusing on the differences between severe and critical patient groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis evaluated bronchoalveolar lavage fluid (BALF) from 53 adult patients diagnosed with severe influenza A (H1N1) pneumonia. Patients were categorized into severe and critical groups depending on the need for invasive ventilation. mNGS was utilized to detect and analyze co-infections, which included fungal, bacterial and viral pathogens. Statistical analysis was conducted to assess the prevalence of these co-infections and their association with clinical outcomes, such as 28-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the cohort, 48 patients (90.6%) experienced co-infections. In the severe group, fungal infections were noted in 14 patients (66.7%), bacterial in 4 patients (19.0%), and viral in 11 patients (52.4%). Among the critical group, 22 patients (68.8%) had fungal, 23 patients (71.9%) had bacterial, and 10 patients (31.3%) had viral co-infections. There was a significantly higher incidence of co-infections in critical patients (\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.0002), with notable differences in\n                      <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                      prevalence between the groups (\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.0339).\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      emerged as the predominant fungal genus across the study. Septic shock (odds ratio [OR] 33.63[4.29\u2212538.3];\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.003) and fungal co-infection (OR 24.42[1.98\u2212810.6];\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.029) were identified as independent risk factors for 28-day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study revealed a high rate of co-infections in both severe and critical patients suffering from influenza A (H1N1) pneumonia, with a higher frequency of bacterial infections in critical patients. Importantly, septic shock and fungal co-infections were independently associated with increased 28-day mortality, highlighting the need for monitoring and management of co-infections in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2025.1669328","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T05:30:21Z","timestamp":1759210221000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of co-infection in severe and critical patients with influenza A (H1N1) pneumonia using metagenomic next-generation sequencing on bronchoalveolar lavage samples"],"prefix":"10.3389","volume":"15","author":[{"given":"Weitao","family":"Gong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaoming","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongzhong","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Zhuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conghui","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanmin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12985-021-01594-0","article-title":"Influenza co-infection associated with severity and mortality in COVID-19 patients","volume":"18","author":"Alosaimi","year":"2021","journal-title":"Virol. 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