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TOPLINE:

A prior influenza virus and respiratory syncytial virus (RSV) infection increased the chance of a secondary Streptococcus pneumoniae infection by more than twice, while having a SARS-CoV-2 infection decreased the risk among hospitalized veterans.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to determine the risk of developing a secondary infection by S pneumoniae after COVID-19.
• The analysis included 188,721 hospitalized veterans (mean age, approximately 70 years; 96% men) who received care at a Veterans Affairs hospital between January 2015 and March 2025.
• Patients were required to have undergone sputum culture or urinary antigen testing for S pneumoniae performed during hospitalization or had positive blood cultures for S pneumoniae with a likely respiratory source.
• Investigators assessed previous viral infections through positive polymerase chain reaction for influenza virus, RSV, or SARS-CoV-2 within 30 days prior to the earliest urinary antigen testing or culture event.

TAKEAWAY:

• Overall, 8165 cases of S pneumoniae infection were detected through urinary antigen testing, sputum culture, and/or positive blood culture.
• Patients with COVID-19 were less likely to develop a secondary S pneumoniae infection (odds ratio [OR], 0.56; 95% CI, 0.50-0.62), while those having influenza and RSV infection had more than twice the risk (OR, 2.39; 95% CI, 2.15-2.64 and OR, 2.50; 95% CI, 2.07-2.99, respectively).
• Additional independent risk factors for S pneumoniae infection included liver disease, cancer, HIV, chronic obstructive pulmonary disease, and smoking.
• At 30 days, the mortality was lower among individuals who tested positive for S pneumoniae (11.1%) compared with those who tested negative (16.8%), with the 1-year mortality rate showing a similar trend (27.7% vs 37.3%).

IN PRACTICE:

“In the post-viral setting of influenza or RSV, empiric antimicrobial therapy with coverage for S pneumoniae should be considered in patients presenting with clinical features suggestive of bacterial superinfection,” the study authors wrote.

SOURCE:

This study was led by Lauren A. Powers, PharmD, Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, New York. It was published online on May 31, 2025, in Clinical Infectious Diseases.

LIMITATIONS:

This study population consisted predominantly of older male veterans. The testing was restricted to influenza virus, RSV, and SARS-CoV-2. This study included only those patients who underwent microbiological testing for S pneumoniae within 30 days following a viral infection. 

DISCLOSURES:

This study received no specific funding, and the authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.