Frequency and antimicrobial resistance pattern of bacterial isolates from patients with COVID-19 in two hospitals of Zanjan
Abstract
Background and Objectives: The outbreak of COVID-19 has been challenging the global health systems. As one of the major associated concerns, microbial co-infections and antimicrobial resistance play critical roles in the prognosis of the disease. This study aims to evaluate co-infections in COVID-19 patients regarding drug resistance.
Materials and Methods: A total number of 5530 Real Time PCR-confirmed COVID-19 cases, who were admitted to two major educational Hospitals in Zanjan, Iran, from February 2019 to February 2020 were included. Respiratory, blood and urine specimens were collected and cultured on selective media. Subsequently, isolates identification, disc diffusion susceptibility tests, and data analysis were carried out.
Results: Bacterial and fungal co-infections were confirmed in 423 patients (8.1%). Co-infections were more prevalent among females (53.2%) than males (46.8%). Coinfected patients had a significantly higher mortality rate compared to those without co-infections (54.8% vs. 12.2%, P<0.001). Acinetobacter baumannii was the most prevalent bacteria isolated from respiratory tract (15.4%) and blood (2.1%). Escherichia coli (12.5%) was the most frequent bacteria in urine. Fungal co-infection was confirmed in 174 (3.36%) patients. Gram-negative bacteria were highly sensitive to colistin (97.85%) and widely resistant to cefixime (91.79%) and trimethoprim-sulfamethoxazole (89.64%). Gram-positive bacteria were considerably sensitive to vancomycin (68%) and nitrofurantoin (66%). Tetracycline and ampicillin were the least effective antibiotics for Gram-positive bacteria with respective resistance rates of 90.91% and 83.33%.
Conclusion: Given the high incidence of bacterial co-infections in COVID-19 patients, it is important to develop rapid and efficient diagnostic, therapeutic and disinfection guidelines to control these infections in the hospitals.
2. Wagner K, Springer B, Imkamp F, Opota O, Greub G, Keller PM. Detection of respiratory bacterial pathogens causing atypical pneumonia by multiplex Lightmix ® RT-PCR. Int J Med Microbiol 2018;308:317-323.
3. Coronavirus disease (COVID-19) How is it transmitted 2020 [2020-10-02]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-how-is-covid-19-transmitted?
4. Timeline of ECDC's reponse to COVID-19 2020 [2020-10-02]. Available from: https://www.ecdc.europa.eu/en/covid-19/timeline-ecdc-response
5. worldometer. coronavirus cases 2020 [2020-10-02]. Available from: https://www.worldometers.info/coronavirus/
6. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46:846-848.
7. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020;26:1622-1629.
8. Whitman WB (2012). The Actinobacteria. In: Bergey's Manual of Systematic Bacteriology. Eds, WB Whitman, M Goodfellow, P Kämpfer, HJ Busse, ME Trujillo, W Ludwig, KI Suzuki. Springer, 2nd ed. New York, USA, pp.1-34.
9. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 26th ed. CLSI supplement M100-S26. Wayne, PA: Clinical and Laboratory Standards Institute; 2016.
10. Clancy CJ, Nguyen MH. Coronavirus disease 2019, superinfections, and antimicrobial development: what can we expect? Clin Infect Dis 2020;71:2736-2743.
11. 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;71:2459-2468.
12. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect 2020;81:266-275.
13. Kang SJ, Jung SI. Age-Related morbidity and mortality among patients with COVID-19. Infect Chemother 2020;52:154-164.
14. Sharifipour E, Shams S, Esmkhani M, Khodadadi J, Fotouhi-Ardakani R, Koohpaei A, et al. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis 2020;20:646.
15. Goncalves Mendes Neto A, Lo KB, Wattoo A, Salacup G, Pelayo J, DeJoy R 3rd, et al. Bacterial infections and patterns of antibiotic use in patients with COVID-19. J Med Virol 2021;93:1489-1495.
16. Bardi T, Pintado V, Gomez-Rojo M, Escudero-Sanchez R, Azzam Lopez A, Diez-Remesal Y, et al. Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome. Eur J Clin Microbiol Infect Dis 2021;40:495-502.
17. Elabbadi A, Turpin M, Gerotziafas GT, Teulier M, Voiriot G, Fartoukh M. Bacterial coinfection in critically ill COVID-19 patients with severe pneumonia. Infection 2021;49:559-562.
18. Asmarawati TP, Rosyid AN, Suryantoro SD, Mahdi BA, Windradi C, Wulaningrum PA, et al. The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya. F1000Res 2021;10:113.
19. Karaba SM, Jones G, Helsel T, Smith LL, Avery R, Dzintars K, et al. Prevalence of co-infection at the time of hospital admission in COVID-19 patients, a multicenter study. Open Forum Infect Dis 2020;8:ofaa578.
20. Martins-Filho PR, Tavares CSS, Santos VS. Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data. Eur J Intern Med 2020;76:97-99.
21. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect 2021;27:83-88.
22. Kamaliaghdam M, Sadeghzadeh M, Jalilvand A, Eftekhari K, Rezaei Z. Antibiotic sensitivity patterns of Escherichia coli isolated in urine samples of patients referred to Ayatollah Mousavi hospital in Zanjan. J Adv Med Biomed Res 2020;28:124-131.
23. Keihanian F, Saeidinia A, Abbasi K, Keihanian F. Epidemiology of antibiotic resistance of blood culture in educational hospitals in Rasht, north of Iran. Infect Drug Resist 2018;11:1723-1728.
| Files | ||
| Issue | Vol 13 No 6 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v13i6.8078 | |
| Keywords | ||
| Bacterial co-infections; COVID-19; Susceptibility testing; SARS-CoV-2 | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
