Co-infection in patients with COVID-19 in Tripoli Northern Lebanon: germs involved and antibiotic sensitivity profile.
DOI:
https://doi.org/10.3823/864Keywords:
COVID-19, Co-infection, Antibioresistance, LebanonAbstract
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.
References
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.
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