Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021

Abstract

Background Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19. Methods We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility. Results Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively. Conclusions In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.

Antibiogram Screening of Bacterial Pathogens Obtained From Respiratory ‎Manifested Patients in Great Cairo ‎

“…Our study declared a considerable high number of isolates obtained from 91 out of 107 laboratory samples (85.04%) belonged to individuals attending different laboratories located in Great Cairo who suffered from upper and lower respiratory manifestation. This prevalence harmonized with that reported in Ghana and Italy as 84.9% and 87.9% respectively [10,11].…”

Bacterial coinfection and antibiotic resistance in hospitalized COVID-19 patients: a systematic review and meta-analysis

“…The included studies were published from 2020 to 2022 from regions of Africa (Egypt) ( Ramadan et al, 2020 ), America (United States, Peru, and Brazil) ( Baggs et al, 2022 ; Copaja-Corzo et al, 2021 ; da Costa et al, 2022 ; Kubin et al, 2021 ; Nori et al, 2021 ), Asia (Pakistan, Saudi Arabia, Qatar, India, Iran, Iraq, China, Indonesia, and Korea) ( Ahmed et al, 2022 ; Alqahtani et al, 2022 ; Baiou et al, 2021 ; Bazaid et al, 2022 ; Bhaskaran, 2022 ; Boorgula et al, 2022 ; Jabir, 2022 ; Jamnani et al, 2022 ; Khurana et al, 2021 ; Li et al, 2020 ; Mahmoudi, 2020 ; Moradi et al, 2021 ; Palanisamy et al, 2021 ; Pourajam et al, 2022 ; Rao et al, 2022 ; Rizvi et al, 2022 ; Said et al, 2022 ; Sathyakamala, Peace & Shanmugam, 2022 ; Sharifipour et al, 2020 ; Sharma et al, 2021 ; Sinto et al, 2022 ; Son et al, 2021 ; Vijay et al, 2021 ; Zeshan et al, 2022 ) and Europe (Turkey, United Kingdoms, Italy, France, Czech Republic, Switzerland, Germany, Greece, and Spain) ( Bahce, Acer & Ozudogru, 2022 ; Baskaran et al, 2021 ; Bentivegna et al, 2021 ; Ceccarelli et al, 2022 ; Contou et al, 2020 ; Cultrera et al, 2021 ; Doubravska et al, 2022 ; Floridia et al, 2022 ; Fontana et al, 2021 ; Foschi et al, 2021 ; Gysin et al, 2021 ; Karataş et al, 2021 ; Karruli et al, 2021 ; Lingscheid et al, 2022 ; Mazzariol et al, 2021 ; Posteraro et al, 2021 ; Protonotariou et al, 2021 ; Suarez-de-la-Rica et al, 2021 ; Temperoni, Caiazzo & Barchiesi, 2021 ...…”

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

“…Key data from the records (demographics, comorbidities, admission to ICU, time interval from hospitalization to death, occurrence of complications, and cause of death as reported on the official death certificate) are reviewed by a team of medical doctors at ISS and entered into a surveillance database. We here analyzed a sample of 157 clinical records from this database already described in a previous paper ( 15 ), for BSI characteristics and correlates. For the present study, hospital charts, documenting the diagnosis of BSI, were further reviewed by two of the authors, who extracted additional information on early (within 48 h from admission) treatment with antibiotics and steroids, time and type of clinical samples collected for microbiological investigations, detected microorganisms, antimicrobial resistance profiles, time from hospitalization and from ICU admission to development of secondary infections.…”

“…In order to explore this issue, we expanded our previous investigations in patients deceased with COVID-19 ( 15 ), with the intent of focusing on the occurrence of bloodstream infections (BSI) after hospitalization for COVID-19. The aim of this analysis was to define the general characteristics of BSI, including causative pathogens, time between admission and occurrence, time between occurrence and death, occurrence in intensive care unit (ICU) or in other wards, and to identify possible risk factors for more rapid development of BSI.…”