Bacterial coinfections in COVID: Prevalence, antibiotic sensitivity patterns and clinical outcomes from a tertiary institute of Northern India

Abstract

Purpose: Bacterial coinfections are a leading cause of morbidity and mortality during viral infections including corona virus disease (COVID-19). The COVID-19 pandemic has highlighted the need to comprehend the complex connection between bacterial and viral infections. During the current pandemic, systematic testing of the COVID-19 patients having bacterial coinfections is essential to choose the correct antibiotics for treatment and prevent the spread of antimicrobial resistance (AMR). This study was planned to study the prevalence, demographic parameters, comorbidities, antibiotic sensitivity patterns, and outcomes in hospitalized COVID-19 patients with bacterial coinfections. Material and Methods: The COVID-19 patients having bacterial coinfections were selected for the study and analyzed for the prevalence, antibiotic sensitivities, comorbidities, and clinical outcomes. The bacterial isolates were identified and the antibiotic susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Of the total 1,019 COVID-19 patients screened, 5.2% ( n = 53) demonstrated clinical signs of bacterial coinfection. Escherichia coli were the most common isolate followed by Pseudomonas aeruginosa and Klebsiella spp . among the gram-negative bacterial infections. Coagulase-negative Staphylococcus species (CONS) and Staphylococcus aureus were most common among the gram-positive bacterial infections. The antibiotic sensitivity profiling revealed that colistin (99%), imipenem (78%), and fosfomycin (95%) were the most effective drugs against the gram-negative isolates while vancomycin (100%), teicoplanin (99%), and doxycycline (71%) were most potent against the gram-positive isolates. The analysis of the clinical parameters and outcomes revealed that among the COVID-19 patients with bacterial coinfections, the mortality rate was higher (39%) than the control group (17%) ( P -value < 0.001). Conclusion: This study reveals the significantly increased rates of bacterial coinfections among COVID-19 patients which may lead to an increase in mortality. This study will guide the physicians at the primary level on the rational and correct usage of antibiotics in such COVID cases. Hence, systematic testing of COVID-19 patients with bacterial coinfections is the need of the hour to decrease the mortality rate and limit the spread of AMR.

Bacterial profiles and their antibiotic resistance background in superinfections caused by multidrug‐resistant bacteria among COVID‐19 ICU patients from southwest Iran

“…In this study, S. aureus (22.4%) was the most frequent Gram‐positive bacterium followed by coagulase‐negative staphylococci (CoNS) that was in line with the previous reports from Italy 37 and India 38 . Moreover, all S. aureus isolates in this study were methicillin‐resistant.…”

“…These inconsistencies in the frequency rate of bacterial causes of superinfections obtained in different studies can be explained by the differences in epidemiology of studied region, studied samples, and the heterogeneity of studied patients in terms of gender, age and other socio‐demographic variables. However, the dysregulated immune system and gut dysbiosis in the COVID‐19 patients could explain the high frequency of Gram‐negative and Gram‐positive bacteria in this study 38 . In COVID‐19 patients, the inflammatory mediators cause the permeability of the intestinal walls to be disrupted, allowing the gut microbes and their metabolites to leak into the bloodstream and to reach the other organs via circulation 38 …”

“…However, the dysregulated immune system and gut dysbiosis in the COVID‐19 patients could explain the high frequency of Gram‐negative and Gram‐positive bacteria in this study 38 . In COVID‐19 patients, the inflammatory mediators cause the permeability of the intestinal walls to be disrupted, allowing the gut microbes and their metabolites to leak into the bloodstream and to reach the other organs via circulation 38 …”

“…35 In previous studies from China 39 and Pakistan, 40 patients could explain the high frequency of Gram-negative and Gram-positive bacteria in this study. 38 In COVID-19 patients, the inflammatory mediators cause the permeability of the intestinal walls to be disrupted, allowing the gut microbes and their metabolites to leak into the bloodstream and to reach the other organs via circulation. 38 In this study, both Gram-negative and Gram-positive isolates showed high resistance rates against majority of tested antibiotics and 68.7% (46/67) of them were MDR.…”

“…38 In COVID-19 patients, the inflammatory mediators cause the permeability of the intestinal walls to be disrupted, allowing the gut microbes and their metabolites to leak into the bloodstream and to reach the other organs via circulation. 38 In this study, both Gram-negative and Gram-positive isolates showed high resistance rates against majority of tested antibiotics and 68.7% (46/67) of them were MDR. All Gram-positive isolates were resistant to clindamycin, cefoxitin, erythromycin, linezolid and majority of them (more than 80.0%) were resistant to ciprofloxacin and trimethoprim/sulfamethoxazole.…”