Co-infection in patients with COVID-19 in Tripoli Northern Lebanon: germs involved and antibiotic sensitivity profile.
Keywords:COVID-19, Co-infection, Antibioresistance, Lebanon
Introduction: A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired bacterial infections. The aim of this study was to investigate the etiology and antimicrobial resistance of bacterial co-infection for more informed antimicrobial treatment.
Methods: This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Northern Lebanon, Nini Hospital between august 2020-september 2021. According to the inclusion and exclusion criteria, patients who acquired bacterial infection were enrolled. Demographic, etiology and antimicrobial resistance data of the co-infection were collected.
Results: The rate of infection by Gram-negative bacteria was 61.7%, while the rate of infection by Gram-positive bacteria was 23.4%. Escherichia coli was the dominant species isolated in this study (25.5%), followed by Candida spp (14.9%). With regard to fungal infection, there were 14.9% cases of yeast infection. The respiratory infection was the majority (42.5%), followed by blood infection (32%) and urine infection (25.5%). The analysis of antibiotics sensitivity results showed us that 44.4% of isolated Enterobacteriaceae were resistant to carbapenem, 16.66% were secretors of ESBL. We noted that 27.77% of Enterobacteriaceae were XDR. All isolates of Staphylococcus aureus were resistant to the methicillin.
Conclusion: Bacterial co-infection may occur in patients hospitalized with COVID-19 and lead to high mortality. Gram-negative bacteria, especially Escherichia coli, S. maltophilia, and P. aeruginosa were the main bacteria, and the resistance rates of the major isolated bacteria were generally high.
Keywords: COVID-19, co-infection, antibioresistance, Lebanon.
WHO-2019-nCoV-FAQ-Virus_origin-2020.1-eng.pdf [Internet]. [cited 2021 Aug 5]. Available from: https://apps.who.int/iris/bitstream/handle/10665/332197/WHO-2019-nCoV-FAQ-Virus_origin-2020.1-eng.pdf
Dissecting the early COVID-19 cases in Wuhan [Internet]. [cited 2021 Dec 18]. Available from: https://www.science.org/doi/epdf/10.1126/science.abm4454?adobe_mc=MCMID%3D24251091375615237552473981978852863225%7CMCORGID%3D242B6472541199F70A4C98A6%2540AdobeOrg%7CTS%3D1639817677
Coronavirus disease (COVID-19) – World Health Organization [Internet]. [cited 2021 Aug 4]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Seven days in medicine: 8-14 Jan 2020. BMJ 2020 Jan 16;m132.
Li J, Wang J, Yang Y, Cai P, Cao J, Cai X, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis. Antimicrob Resist Infect Control 2020 Dec;9(1):153.
Mahmoudi H. Bacterial co-infections and antibiotic resistance in patients with COVID-19. GMS Hyg Infect Control 2020 Dec 17;15:Doc35.
Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection [Internet]. 2021 Mar 11 [cited 2021 Jul 25]; Available from: http://link.springer.com/10.1007/s15010-021-01602-z
He Y, Li W, Wang Z, Chen H, Tian L, Liu D. Nosocomial infection among patients with COVID-19: A retrospective data analysis of 918 cases from a single center in Wuhan, China. Infect Control Hosp Epidemiol. 2020;41(8):982-983.
Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis 2020;2: ciaa530.
Fu Y, Yang Q, Xu M, Kong H, Chen H, Fu Y, et al. Secondary Bacterial Infections in Critical Ill Patients With Coronavirus Disease 2019. Open Forum Infect Dis 2020; 1;7(6):ofaa220.
Rawson TM, Wilson RC, Holmes A. Understanding the role of bacterial and fungal infection in COVID-19. Clin Microbiol Infect2021;27(1):9–11.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study | Elsevier Enhanced Reader [Internet]. [cited 2021 Nov 17]. Available from: https://reader.elsevier.com/reader/sd/pii/S0140673620305663?token=6457F326B0951198E70CA32BD353DAA7EE5A927119A261D191181565B9A9445B6049B1153727AC76A3A695B86E6B71B1&originRegion=eu-west-1&originCreation=20211117084703
Morris DE, Cleary DW, Clarke SC. Secondary Bacterial Infections Associated with Influenza Pandemics. Front Microbiol [Internet]. 2017 [cited 2022 Jan 10];0. Available from: https://www.frontiersin.org/articles/10.3389/fmicb.2017.01041/full
Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia. 2021;13(1):5.
Référentiel en microbiologie Médicale - Société Française de Microbiologie [Internet]. [cited 2021 Dec 2]. Available from: https://www.sfm microbiologie.org/boutique/referentiel-en-microbiologie-medicale-remic/
Khurana S, Singh P, Sharad N, Kiro VV, Rastogi N, Lathwal A, et al. Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: Implication on antimicrobial resistance. Indian J Med Microbiol2021;1,39(2):147–53.
Gysin M, Acevedo CT, Haldimann K, Bodendoerfer E, Imkamp F, Bulut K, et al. Antimicrobial susceptibility patterns of respiratory Gram-negative bacterial isolates from COVID-19 patients in Switzerland [Internet]. Infectious Diseases (except HIV/AIDS); 2021 Mar [cited 2021 Jul 30]. Available from: http://medrxiv.org/lookup/doi/10.1101/2021.03.10.21253079
Vijay S, Bansal N, Rao BK, Veeraraghavan B, Rodrigues C, Wattal C, et al. Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience. Infect Drug Resist. 2021;24(14):1893–903.
Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world | Elsevier Enhanced Reader [Internet]. [cited 2021 Dec 9]. Available from: https://reader.elsevier.com/reader/sd/pii/S2666016421000153?token=76640667D2D37FEDDEDA360C3CE973EF1148B0F515D1CF3F32A8B330CD1BD4059DF411DEA7BDCB079638020DDD11F5A3&originRegion=eu-west-1&originCreation=20211209142529
Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect 2020;26(10):1395–9.
Bordi L, Nicastri E, Scorzolini L, Di Caro A, Capobianchi MR, Castilletti C, et al. Differential diagnosis of illness in patients under investigation for the novel coronavirus (SARS-CoV-2), Italy, February 2020. Eurosurveillance [Internet]. 2020 Feb 27 [cited 2021 Nov 17];25(8). Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.8.2000170
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet 2020;15;395(10223):507–13.
Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients | Elsevier Enhanced Reader [Internet]. [cited 2021 Jul 25]. Available from: https://reader.elsevier.com/reader/sd/pii/S2666379121000458?token=6E2E0B8BC1D132A1ED2E4AF3D1CA6751B0948D197E7A077287735A3AB08611EA264A1CB56BA93D6E11528252AE8BD4D6&originRegion=eu-west-1&originCreation=20210725193816
Verroken A, Scohy A, Gérard L, Wittebole X, Collienne C, Laterre P-F. Co-infections in COVID-19 critically ill and antibiotic management: a prospective cohort analysis. Crit Care. 2020;24(1):410.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020; 15;395(10223):497–506.
Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol2020;127:104364.
Blasco ML, Buesa J, Colomina J, Forner MJ, Galindo MJ, Navarro J, et al. Co-detection of respiratory pathogens in patients hospitalized with Coronavirus viral disease-2019 pneumonia. J Med Virol 2020;92(10):1799–801.
Duployez C, Le Guern R, Tinez C, Lejeune A-L, Robriquet L, Six S, et al. Panton-Valentine Leukocidin–Secreting Staphylococcus aureus Pneumonia Complicating COVID-19. Emerg Infect Dis 2020;26(8):1939–41.
Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis | Elsevier Enhanced Reader [Internet]. [cited 2021 Nov 17]. Available from: https://reader.elsevier.com/reader/sd/pii/S1198743X20304237?token=04F67E9E6923782FC67535372031D46A85804466714C838FFF917DC64141FA622E2A29550FF739BCA1F6DC2CE49B1929&originRegion=eu-west-1&originCreation=20211117133629
Dudoignon E, Caméléna F, Deniau B, Habay A, Coutrot M, Ressaire Q, et al. Bacterial Pneumonia in COVID-19 Critically Ill Patients: A Case Series. Clin Infect Dis 2021;72(5):905–6.
Copyright (c) 2022 Moustapha Khodor, Monzer Hamze, Hassan Mallat, Zahia Chahine, George Chalouhi, Marcel Achkar, Nadim Azar
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles are published Under License of Creative Commons Attribution 3.0 License Â©
Copyright policies & self-archiving
This is our Copyright Policy. We are a RoMEO green journal.
|Author's Pre-print:||author can archive pre-print (ie pre-refereeing)|
|Author's Post-print:||author can archive post-print (ie final draft post-refereeing)|
|Publisher's Version/PDF:||author can archive publisher's version/PDF|