{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:51:42Z","timestamp":1790279502989,"version":"4.1.0"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Humans are affected by respiratory infections globally, originating from both bacterial and viral agents. However, the pathogens responsible for respiratory tract infections and the specific effects of viral-viral, viral-bacterial, and bacterial-bacterial co-infections on disease progression and clinical outcomes remain unclear. \u0422his study aimed to determine the prevalence, estimate the age burden, and provide clinical characteristics of mono- and co-infections involving various bacterial and viral co-pathogens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 609 nasopharyngeal specimens were collected from outpatients and hospitalized patients with respiratory symptoms between April and December 2024. The specimens were analyzed using an in-house multiplex real-time polymerase chain reaction method. Six separate primer and probe mixtures were prepared to detect 15 respiratory viruses and 5 common bacterial respiratory pathogens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study, conducted over an 8-month period, found that 65.7% of the patients (400) had at least one respiratory pathogen, with viral infections (49.2%) being more common than bacterial infections (16.5%). Infections were categorized as follows: Viral mono-infections: 217 cases (35.6%); Bacterial-bacterial co-infections: 6 cases (1%); Viral-viral co-infections: 39 cases (6.4%); and Bacterial-viral co-infections: 87 cases (34.3%). Common pathogens causing mono- and co-infections included SARS-CoV-2, rhinovirus, influenza A\/B, bocavirus, adenovirus,\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      , and\n                      <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                      . Mixed infections were more common in children aged &amp;lt;5\u202fyears (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). The disease resulted in a fatal outcome in four patients (1.3%). Notably, one patient with confirmed\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      serotype 11A\/D had a fatal outcome. Analysis of age as a factor in infection severity revealed that infants aged 7\u201311\u202fmonths and patients aged &amp;gt;65\u202fyears with bacterial-viral co-infections had mean saturations of 89.6\u202f\u00b1\u202f10.4% and 90\u202f\u00b1\u202f5%, respectively. Moreover, hospitalized patients aged &amp;gt;65 with viral-viral co-infections exhibited significantly higher C-reactive protein levels (150.8\u202f\u00b1\u202f14.3\u202fmg\/L) compared to children aged &amp;lt; 15 (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study identified SARS-CoV-2, rhinoviruses, adenoviruses, and\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      as key respiratory pathogens associated with mono- and co-infections. Mixed infections with SARS-CoV-2 were associated with progressively worsening symptoms, particularly in patients aged &amp;gt;65\u202fyears. This study highlights the need for preventive measures, including vaccination and revaccination of older adults with vaccines covering a broader range of\n                      <jats:italic>S. pneumoniae<\/jats:italic>\n                      serotypes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1597782","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T08:47:56Z","timestamp":1761209276000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Respiratory infections in the post-COVID-19 era: impact, prevalence, and clinical characteristics of bacterial and viral co-infections"],"prefix":"10.3389","volume":"12","author":[{"given":"I.","family":"Trifonova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Korsun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Levterova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Pavlova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Simeonovski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ivanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Velikov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Voleva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Ivanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Ivanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Dakov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Tcherveniakova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Angelova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Christova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1325236","DOI":"10.3389\/fmed.2024.1325236","article-title":"Disease burden and high-risk populations for complications in patients with acute respiratory infections: a scoping review","volume":"11","author":"Cui","year":"2024","journal-title":"Front Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e1003057","DOI":"10.1371\/journal.ppat.1003057","article-title":"Viral and bacterial interactions in the upper respiratory tract","volume":"9","author":"Bosch","year":"2013","journal-title":"PLoS Pathog"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/00001432-200406000-00003","article-title":"How do viral infections predispose patients to bacterial infections?","volume":"17","author":"Beadling","year":"2004","journal-title":"Curr Opin Infect Dis"},{"key":"ref4","article-title":"Infections of the respiratory system","volume-title":"Medical Microbiology","author":"Dasaraju","year":"1996"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/B978-0-12-800886-7.00011-X","article-title":"Molecular testing for respiratory viruses","author":"Stellrecht","year":"2016","journal-title":"Diagn Mol Pathol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/B978-0-323-55512-8.00033-8","article-title":"Viral respiratory infections. 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