Poor Prognosis of Pneumococcal Co-Infection in Hospitalized Patients with COVID-19: A Propensity Score-Matched Analysis

The impact of <i>Streptococcus pneumoniae</i> coinfection on coronavirus disease 2019 (COVID-19) prognosis remains uncertain. We conducted a retrospective analysis of patients hospitalized with COVID-19 who underwent a pneumococcal urinary antigen (PUA) test to assess its clinical utility. Results showed that PUA-positive patients required more oxygen support, high-flow nasal cannula, and dexamethasone compared to PUA-negative patients. Furthermore, the significantly higher incidence of a National Early Warning Score ≥5 in the PUA-positive group (<i>P</i><0.001) suggests that a positive PUA test is associated with a severe disease course. However, no significant difference in mortality was observed between the two groups, and antibiotics were used in almost all patients (96.2%). While the PUA test may help guide antibiotic use in COVID-19 patients, its interpretation should be approached with caution.