COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria

Abstract

Bacterial co-infections may aggravate COVID-19 disease, and therefore being cognizant of other pathogens is imperative. We studied the types, frequency, antibiogram, case fatality rates (CFR), and clinical profiles of co-infecting-pathogens in 301 COVID-19 patients. Co-infection was 36% (n = 109), while CFR was 31.2% compared to 9.9% in non-co-infected patients (z-value = 3.1). Four bacterial species dominated, namely, multidrug-resistant Klebsiella pneumoniae (37%, n = 48), extremely drug-resistant Acinetobacter baumannii (26%, n = 34), multidrug-resistant Eschericia. coli (18.6%, n = 24), and extremely drug-resistant Pseudomonas aeruginosa (8.5%, n = 11), in addition to other bacterial species (9.3%, n = 12). Increased co-infection of K. pneumoniae and A. baumannii was associated with increased death rates of 29% (n = 14) and 32% (n = 11), respectively. Klebsiella pneumoniae was equally frequent in respiratory and urinary tract infections (UTI), while E. coli mostly caused UTI (67%), and A. baumannii and P. aeruginosa dominated respiratory infections (38% and 45%, respectively). Co-infections correlated with advance in age: seniors ≥ 50 years (71%), young adults 21–49 years (25.6%), and children 0–20 years (3%). These findings have significant clinical implications in the successful COVID-19 therapies, particularly in geriatric management. Future studies would reveal insights into the potential selective mechanism(s) of Gram-negative bacterial co-infection in COVID-19 patients.

Multidrug resistant bacterial infections in severely ill COVID-19 patients admitted in a national referral and teaching hospital, Kenya

“…The most dominant bacterium causing infections in COVID-19 patients varies widely across the published literature, with Pseudomonas aeruginosa and Escherichia coli [ 43 ], Staphylococcus aureus [ 13 , 39 ] Streptococcus pneumonia [ 43 ] and Escherichia coli [ 44 ] as the most common bacterial isolates. In our study, Klebsiella pneumoniae (23.9%, 16/67) was the most common bacterial isolate, similar to that recorded by Said and colleagues [ 45 ]. Though the hypervirulence mechanisms of K. pneumonia are unclear in COVID-19, MDR and hypervirulent pathotypes contribute to the global epidemiology of this pathogen[ 45 ].…”

“…In our study, Klebsiella pneumoniae (23.9%, 16/67) was the most common bacterial isolate, similar to that recorded by Said and colleagues [ 45 ]. Though the hypervirulence mechanisms of K. pneumonia are unclear in COVID-19, MDR and hypervirulent pathotypes contribute to the global epidemiology of this pathogen[ 45 ]. All K. pneumoniae in our study were MDR and 31.2% resistant to colistin, which may explain the predominance among the study population.…”

Complementary Sets of Autoantibodies Induced by SARS-CoV-2, Adenovirus and Bacterial Antigens Cross-React with Human Blood Protein Antigens in COVID-19 Coagulopathies

“…Additionally, antibodies against a number of bacterial coinfections that are often found in severe cases of COVID-19, such as Acinetobacter baumannii , Haemophilus influenzae , Pseudomonas aeruginosa , Mycoplasma pneumoniae , etc. [ 131 , 132 , 133 , 134 ] remain to be explored for cross-reactivities with blood proteins implicated as autoimmune targets in COVID-19 coagulopathies.…”

Problems Associated with Co-Infection by Multidrug-Resistant Klebsiella pneumoniae in COVID-19 Patients: A Review

“…Said et al [ 49 ] screened for microbial co-infection in 301 patients infected by SARS-CoV-2. Among the main detected microbes were multidrug-resistant K. pneumoniae (37%), followed by 26% of cases infected by extremely drug-resistant A. baumannii , 18.6% of cases infected by multidrug-resistant E. coli , 8.5% of cases infected by extremely drug-resistant P. aeruginosa , and 9.3% of cases infected with other bacteria.…”