Associação da COVID-19 às superinfecções e coinfecções bacterianas multirresistentes: revisão integrativa / Association of COVID-19 to multidrug-resistant bacterial superinfections and coinfections: an integrative review

Abstract

Introdução: A COVID-19 é uma doença pandêmica que pode estar relacionada a eventos concomitantes ou secundários à sua manifestação, como as coinfecções e superinfecções bacterianas. Outro aspecto relevante nessa hipótese é a participação de agentes multirresistentes no cuidado em saúde e no uso consciente dos antibacterianos. Objetivo: Descrever os agentes participantes nas coinfecções e (ou) superinfecçõesbacterianas multirresistentes associadas à COVID-19 em pacientes hospitalizados conforme a literatura científica de março de 2020 a junho de 2021. Método: Revisão integrativa (RI) da literatura, descritiva e estruturada conforme as suas seis fases características. Para tal, o Portal Regional da Biblioteca Virtual em Saúde (BVS) e a PubMed foram nossas bases de busca. Resultados: Esta RI obteve estudos de diferentes métodos e países que realçaram uma importante participação de pacientes do sexo masculino com COVID-19, bem como o uso de imunossupressores,imunomoduladores e antibióticos previamente as infecções bacterianas multirresistentes. As bactérias Gram-negativas foram evidentes tanto na coinfecção quanto na superinfecção, se destacando pelo seu perfil de resistência principalmente as classes dos beta-lactâmicos, quinolonas, macrolídeos e sulfonamidas; e produtoras das enzimas beta-lactamases de espectro estendido (ESBL), Metalo-beta-lactamases (MBL) ecarbapenemases. Nas Gram-positivas presentes se destacaram Staphylococcus aureus meticilina resistentes (MRSA) e Enterococcus faecalis resistentes à vancomicina (VRE) com resistência às outras classes analisadas. Conclusão: As bactérias Gram-negativas foram mais presentes nos episódios de coinfecção e superinfecção multirresistentes associadas à COVID-19, cujo perfil de resistência abrangeu as classes dos betalactâmicos, quinolonas, macrolídeos e sulfonamidas, bem como a produção das enzimas ESBL, MBL e carbapenemase. MRSA e VRE são destaquesentre as Gram-positivas identificadas, sendo estas resistentes às outras classes colocadas em análise na amostra.Palavras-chave: COVID-19, Superinfecção, Coinfecção, Bactérias, Antibacterianos. ABSTRACT:Introduction: COVID-19 is a pandemic disease that may be related to concomitant or secondary events to its manifestation, such as bacterial coinfections and superinfections. Another relevant aspect of this hypothesis is the participation of multidrug-resistant agents in health care and the conscious use of antibacterial agents. Objective: The aim of this study was to describe the bacteria that participated in multidrug-resistant bacterial coinfections and superinfections associated with COVID-19 in hospitalized patients according to the scientific literature from March 2020 to June 2021. Method: Integrative review (IR) of the literature, this descriptive study was structured according to its six characteristic phases. To this end, the Regional Portal of the Virtual Health Library (VHL) and PubMed were our search bases. Results: This IR obtained studies from different methods and countries that highlighted an important participation of male patients with COVID-19, as well as the use of immunosuppressants, immunomodulators, and antibiotics prior to multidrug-resistant bacterial infections. The Gram-negative bacteria were evident in coinfection and superinfection, standing out for their resistance profile, especially the classes of beta-lactams, quinolones, macrolides, and sulfonamides, as well as the producers of extended-spectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and carbapenemases enzymes. In the Gram-positive bacteria present, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecalis (VRE)stood out with resistance to the other analyzed classes. Conclusion: The Gram-negative bacteria were more present in episodes of coinfection and superinfection multidrug-resistant in COVID-19, whose resistance profile encompassed the classes of beta-lactams, quinolones, macrolides, and sulfonamides, as well as the producers of ESBL, MBL, and carbapenemases enzymes. MRSA and VRE were prominent among the identified Gram-positive bacteria, and they were resistant to other classes analyzed in the sample.Keywords: COVID-19, Superinfection, Coinfection, Bacteria, Antibacterial agents.

Frequency of Multidrug-Resistant Microorganisms Associated with Bacterial Coinfections in Hospitalized Patient with Covid-19: A Literature Review

“…Additionally, we observed that the majority of COVID-19 patients with coinfections were male, reaching up to 80% in some studies [16,22]. Studies suggest that most coinfections involve male patients, which is an additional independent risk factor in the more severe cases of this condition, in addition to the major comorbidities and the use of immunosuppressive medications that favor this outcome [37][38][39].…”

"Multidrug-Resistant Bacteria Related to Covid-19 Infection: A Minireview"

“…The World Health Organization (WHO) recorded antimicrobial multidrug resistance as one of the biggest health risks in 2019. Some of the causes for this acquired resistance are misinformation about the function of antibiotics, leading part of the population to self-medicate to treat common viral infections, inadequate prescription due to inaccurate diagnosis, pollution of the environment with antibiotics and their use in the treatment of animals in areas such as veterinary, and agriculture [1][2][3][4]. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is a single-stranded, positive-sense RNA zoonotic virus identified in late 2019 in Wuhan, China, which spread around the world rapidly, causing a pandemic of the disease called Coronavirus Disease-19 .…”

“…The most severe cases of infection require mechanical ventilation and intensive care treatment, with prolonged stays in the hospital environment, which characterizes a very increased risk and predisposition to secondary and opportunistic infections [2,5,6]. In the first phase of the pandemic, from December 2019 to June 2020, antibiotic prescription reached 82.3%, in contrast to 39.7% in the second phase, between June 2020 and March 2021, according to a study by Cong et al published in 2022 [7].…”