{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T07:58:04Z","timestamp":1784447884074,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Barri Casanovas Private Foundation Scholarship","award":["FBC02\/2023"],"award-info":[{"award-number":["FBC02\/2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Bacterial\/fungal coinfections (COIs) are associated with antibiotic overuse, poor outcomes such as prolonged ICU stay, and increased mortality. Our aim was to develop machine learning-based predictive models to identify respiratory bacterial or fungal coinfections upon ICU admission. Methods: We conducted a secondary analysis of two prospective multicenter cohort studies with confirmed influenza A (H1N1)pdm09 and COVID-19. Multiple logistic regression (MLR) and random forest (RF) were used to identify factors associated with BFC in the overall population and in each subgroup (influenza and COVID-19). The performance of these models was assessed by the area under the ROC curve (AUC) and out-of-bag (OOB) methods for MLR and RF, respectively. Results: Of the 8902 patients, 41.6% had influenza and 58.4% had SARS-CoV-2 infection. The median age was 60 years, 66% were male, and the crude ICU mortality was 25%. BFC was observed in 14.2% of patients. Overall, the predictive models showed modest performances, with an AUC of 0.68 (MLR) and OOB 36.9% (RF). Specific models did not show improved performance. However, age, procalcitonin, CRP, APACHE II, SOFA, and shock were factors associated with BFC in most models. Conclusions: Machine learning models do not adequately predict the presence of co-infection in critically ill patients with pandemic virus infection. However, the presence of factors such as advanced age, elevated procalcitonin or CPR, and high severity of illness should alert clinicians to the need to rule out this complication on admission to the ICU.<\/jats:p>","DOI":"10.3390\/antibiotics13100968","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T04:42:15Z","timestamp":1729140135000},"page":"968","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Machine Learning Approach to Determine Risk Factors for Respiratory Bacterial\/Fungal Coinfection in Critically Ill Patients with Influenza and SARS-CoV-2 Infection: A Spanish Perspective"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-5984","authenticated-orcid":false,"given":"Alejandro","family":"Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain"},{"name":"Pere Virgili Health Research Institute, 43005 Tarragona, Spain"},{"name":"Centre for Biomedical Research Network Respiratory Diseases (CIBERES), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain"},{"name":"Technical Secretary\u2019s Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-4063","authenticated-orcid":false,"given":"Ignacio","family":"Mart\u00edn-Loeches","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James\u2019 Hospita, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Claverias","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Pere Virgili Health Research Institute, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3637-3821","authenticated-orcid":false,"given":"Emili","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitari Parc Tauli, 08208 Sabadell, Spain"},{"name":"Medicine Faculty, Universitat Aut\u00f3noma de Barcelona, 08193 Sabadell, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6593-5486","authenticated-orcid":false,"given":"Rafael","family":"Zaragoza","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Dr. Peset, 46017 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio","family":"Borges-Sa","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Son Llatzer, 07198 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"G\u00f3mez-Bertomeu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain"},{"name":"Pere Virgili Health Research Institute, 43005 Tarragona, Spain"},{"name":"Microbiology\/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain"},{"name":"Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1976-3641","authenticated-orcid":false,"given":"\u00c1lvaro","family":"Franquet","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain"},{"name":"Technical Secretary\u2019s Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Trefler","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Pere Virgili Health Research Institute, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Gonz\u00e1lez Garz\u00f3n","sequence":"additional","affiliation":[{"name":"Postgrado Medicina Cr\u00edtica y Cuidado Intensivo, Facultad de Medicina, Fundaci\u00f3n Universitari Ciencias de la Salud, Distrito Especial, Cra. 54 No.67A-80, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lissett","family":"Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Postgrado Medicina Cr\u00edtica y Cuidado Intensivo, Facultad de Medicina, Fundaci\u00f3n Universitari Ciencias de la Salud, Distrito Especial, Cra. 54 No.67A-80, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florencia","family":"Al\u00e9s","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Dr. Alejandro Guti\u00e9rrez, Venado Tuerto S2600, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Sancho","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitrio y Polit\u00e9cnico La Fe, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Sol\u00e9-Viol\u00e1n","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Dr. Negrin, 35010 Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0665-557X","authenticated-orcid":false,"given":"\u00c1ngel","family":"Estella","sequence":"additional","affiliation":[{"name":"Critical Care Department, University Hospital of Jerez, INIBiCA, 11407 Jerez, Spain"},{"name":"Faculty of Medicine, University of C\u00e1diz, 11407 Jerez, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1015-9780","authenticated-orcid":false,"given":"Julen","family":"Berrueta","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Garc\u00eda-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borja","family":"Suberviola","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Guardiola","sequence":"additional","affiliation":[{"name":"Robley Rex VA Medical Center, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7652-8379","authenticated-orcid":false,"given":"Mar\u00eda","family":"Bod\u00ed","sequence":"additional","affiliation":[{"name":"Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain"},{"name":"Pere Virgili Health Research Institute, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Simonsen, L., Spreeuwenberg, P., Lustig, R., Taylor, R.J., Fleming, D.M., Kroneman, M., Van Kerkhove, M.D., Mounts, A.W., Paget, W.J., and the GLaMOR Collaborating Teams (2013). Global Mortality Estimates for the 2009 Influenza Pandemic from the GLaMOR Project: A Modeling Study. PLoS Med., 10.","DOI":"10.1371\/journal.pmed.1001558"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/S1473-3099(12)70152-4","article-title":"Global mortality of 2009 pandemic influenza A H1N1","volume":"9","author":"Viboud","year":"2012","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","unstructured":"Mathieu, E., Ritchie, H., Rod\u00e9s-Guirao, L., Appel, C., Giattino, C., Hasell, J., Macdonald, B., Dattani, S., Beltekian, D., and Ortiz-Ospina, E. (2024, August 03). \u201cCoronavirus Pandemic (COVID-19)\u201d. 2020 Published online at OurWorldInData.org. Available online: https:\/\/ourworldindata.org\/coronavirus."},{"key":"ref_4","unstructured":"World Health Organization (2024, August 13). 2023 Data.who.int. WHO Coronavirus (COVID-19) Dashboard > Deaths [Dashboard]. Available online: https:\/\/data.who.int\/dashboards\/covid19\/deaths."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s00134-016-4578-y","article-title":"Increased incidence of co-infection in critically ill patients with influenza","volume":"43","author":"Schultz","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jinf.2015.11.007","article-title":"Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis","volume":"72","author":"Schuetz","year":"2016","journal-title":"J. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100243","DOI":"10.1016\/j.lanepe.2021.100243","article-title":"Mortality comparison between the first and second\/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study","volume":"11","author":"Carbonell","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.medin.2022.05.005","article-title":"Antibiotics in development for multiresistant gram-negative bacilli","volume":"46","author":"Moreno","year":"2022","journal-title":"Med. Intensiv. (Engl. Ed.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13756-022-01085-z","article-title":"Antimicrobial resistance (AMR) in COVID-19 patients: A systematic review and meta-analysis (November 2019\u2013June 2021)","volume":"11","author":"Kariyawasam","year":"2022","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1093\/cid\/ciaa530","article-title":"Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescribing","volume":"71","author":"Rawson","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3265","DOI":"10.1007\/s10238-023-01116-y","article-title":"A systematic review of the clinical characteristics of influenza-COVID-19 co-infection","volume":"23","author":"Varshney","year":"2023","journal-title":"Clin. Exp. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Delhommeau, G., Buetti, N., Neuville, M., Siami, S., Cohen, Y., Laurent, V., Mourvillier, B., Reignier, J., Goldgran-Toledano, D., and Schwebel, C. (2022). Bacterial Pulmonary Co-Infections on ICU Admission: Comparison in Patients with SARS-CoV-2 and Influenza Acute Respiratory Failure: A Multicentre Cohort Study. Biomedicines, 10.","DOI":"10.3390\/biomedicines10102646"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13054-023-04312-0","article-title":"COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation","volume":"27","author":"Patton","year":"2023","journal-title":"Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Carbonell, R., Moreno, G., Mart\u00edn-Loeches, I., Bod\u00ed, M., and Rodr\u00edguez, A. (2023). The Role of Biomarkers in Influenza and COVID-19 Community-Acquired Pneumonia in Adults. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010161"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Carbonell, R., Moreno, G., Mart\u00edn-Loeches, I., Gomez-Bertomeu, F., Sarvis\u00e9, C., G\u00f3mez, J., Bod\u00ed, M., D\u00edaz, E., Papiol, E., and Trefler, S. (2021). Prognostic Value of Procalcitonin and C-Reactive Protein in 1608 Critically Ill Patients with Severe Influenza Pneumonia. Antibiotics, 10.","DOI":"10.3390\/antibiotics10040350"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.jinf.2022.06.024","article-title":"Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical COVID-19 patients","volume":"85","author":"Carbonell","year":"2022","journal-title":"J. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.cmi.2023.03.017","article-title":"Clinical outcomes of the severe acute respiratory syndrome coronavirus 2 Omicron and Delta variant: Systematic review and meta-analysis of 33 studies covering 6 037 144 coronavirus disease 2019-positive patients","volume":"29","author":"Hu","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.jiac.2024.02.026","article-title":"Difference in the impact of coinfections and secondary infections on antibiotic use in patients hospitalized with COVID-19 between the Omicron-dominant period and the pre-Omicron period","volume":"30","author":"Murakami","year":"2024","journal-title":"J. Infect. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e335","DOI":"10.1016\/S2468-2667(21)00055-4","article-title":"Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: An ecological study","volume":"6","author":"Graham","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"For the Efraim investigators and the Nine-I study group, Martin-Loeches, I., Lemiale, V., Geoghegan, P., McMahon, M.A., Pickkers, P., Soares, M., Perner, A., Meyhoff, T.S., and Bukan, R.B. (2019). Influenza and associated co-infections in critically ill immunosuppressed patients. Crit. Care, 23, 152.","DOI":"10.1186\/s13054-019-2425-6"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1056\/NEJMsb2104756","article-title":"SARS-CoV-2 Variants in Patients with Immunosuppression","volume":"385","author":"Corey","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_23","first-page":"100747","article-title":"Impact of COVID-19 on immunocompromised populations during the Omicron era: Insights from the observational population-based INFORM study","volume":"35","author":"Evans","year":"2023","journal-title":"Lancet Reg. Health\u2014Eur."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Oliva, I., Ferr\u00e9, C., Daniel, X., Cartany\u00e0, M., Villavicencio, C., Salgado, M., Vidaur, L., Papiol, E., de Molina, F.G., and Bod\u00ed, M. (2024). Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: A multicenter study. Med. Intensiv. (Engl. Ed.), in press.","DOI":"10.1016\/j.medine.2024.06.022"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s13054-021-03487-8","article-title":"Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain","volume":"25","author":"Herrera","year":"2021","journal-title":"Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciy866","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza","volume":"68","author":"Uyeki","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","unstructured":"WHO (2024, August 13). Clinical Management of Severe Acute Respiratory Infection (SARI) When COVID-19 Disease is Suspected: Interim Guidance. 13 March 2020. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/331446\/WHO-2019-nCoV-clinical-2020.4-eng.pdf?sequence=1&isAllowed=y."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1007\/s00134-020-06091-6","article-title":"Review of influenza-associated PA in ICU patients and proposal for a case definition: An expert opinion","volume":"46","author":"Verweij","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.medin.2021.12.005","article-title":"Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia","volume":"46","author":"Claverias","year":"2022","journal-title":"Med. Intensiv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"79","DOI":"10.32614\/RJ-2014-008","article-title":"ROSE: A Package for Binary Imbalanced Learning","volume":"6","author":"Lunardon","year":"2014","journal-title":"R J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s10618-012-0295-5","article-title":"Training and assessing classification rules with imbalanced data","volume":"28","author":"Menardi","year":"2014","journal-title":"Data Min. Knowl. Discov."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/j.2517-6161.1969.tb00796.x","article-title":"Tests for Specification Errors in Classical Linear Least-Squares Regression Analysis","volume":"21","author":"Ramsey","year":"1969","journal-title":"J. R. Stat. Soc. Ser. B (Methodol.)"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106324","DOI":"10.1016\/j.ijantimicag.2021.106324","article-title":"Increased antimicrobial resistance during the COVID-19 pandemic","volume":"57","author":"Lai","year":"2021","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Su, L., Yu, T., Zhang, C., Huo, P., and Zhao, Z. (2024). A prediction model for secondary invasive fungal infection among severe SARS-CoV-2 positive patients in ICU. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1382720"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"154272","DOI":"10.1016\/j.jcrc.2023.154272","article-title":"Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy","volume":"76","author":"Janssen","year":"2023","journal-title":"J. Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13756-024-01392-7","article-title":"Development and validation of machine learning-based models for predicting healthcare-associated bacterial\/fungal infections among COVID-19 inpatients: A retrospective cohort study","volume":"13","author":"Wang","year":"2024","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1093\/eurpub\/ckad060","article-title":"Epidemiology of bacterial co-infections and risk factors in COVID-19-hospitalized patients in Spain: A nationwide study","volume":"33","author":"Prada","year":"2023","journal-title":"Eur. J. Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e067101","DOI":"10.1136\/bmjopen-2022-067101","article-title":"Comparison of COVID-19 with influenza A in the ICU: A territory-wide, retrospective, propensity matched cohort on mortality and length of stay","volume":"13","author":"Chu","year":"2023","journal-title":"BMJ Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1007\/s15010-022-01801-2","article-title":"Predictive model for bacterial co-infection in patients hospitalized for COVID-19: A multicenter observational cohort study","volume":"50","author":"Giannella","year":"2022","journal-title":"Infection"},{"key":"ref_40","first-page":"1475","article-title":"Predictors of Pneumococcal Co-infection for Patients with Pandemic (H1N1) 2009","volume":"17","author":"Padilla","year":"2011","journal-title":"Emerg. Infect. Dis."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/10\/968\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:12:43Z","timestamp":1760112763000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/10\/968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,14]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["antibiotics13100968"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13100968","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,14]]}}}