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Secondary bacterial infections in patients with coronavirus disease 2019-associated pneumonia
Ozlem Aydemir1, Yusuf Aydemir2, Elif Özözen Şahin1
1Sakarya University, Faculty of Medicine, Department of Medical Microbiology - Sakarya, Turkey.
Objective:
The vast majority of patients who hospitalized with coronavirus disease 2019 are given empirical antibiotic therapy. However, information on the frequency, microorganism species, and resistance rates of secondary bacterial infections in coronavirus disease 2019 patients are insufficient. We aimed to show the frequency of secondary infections and resistance conditions in patients with coronavirus disease 2019 hospitalized in the intensive care unit.
Methods:
The results of tracheal aspirate culture, blood culture, and urine culture obtained from coronavirus disease 2019 patients - at least 2 days after their admission to the intensive care unit - were examined microbiologically.
Results:
A total of 514 patients hospitalized in intensive care unit were included in our study. Tracheal aspirate, blood, or urine cultures were collected from 369 patients (71.8%). Bacterial reproduction was detected in at least one sample in 171 (33.3%) of all patients. The rate of respiratory tract infection and/or bloodstream infection was found to be 21%. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in tracheal aspirate culture; Coagulase-negative staphylococci, K. pneumoniae, and A. baumannii in blood culture; and Escherichia coli, K. pneumoniae, and Enterococcus faecalis in urine culture were the most common microorganisms. A. baumannii was resistant to most antibiotics except colistin and P. aeruginosa strains were resistant to most antibiotics except amikacin, colistin, cefepime, and imipenem. In K. pneumoniae, the highest meropenem sensitivity (73%) was observed; there was a strong resistance to most of the remaining antibiotics.
Conclusions:
We think that our study can be useful in choosing empirical antibiotic therapy in the coronavirus disease 2019 pandemic and reducing the mortality that may occur with secondary infection.
Insights
Secondary bacterial infections are common in intensive care unit patients with coronavirus disease 2019. Acinetobacter baumannii and Klebsiella pneumoniae showed significant antibiotic resistance, impacting empirical therapy choices.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Empirical antibiotic therapy is standard for hospitalized coronavirus disease 2019 (COVID-19) patients.
- Data on secondary bacterial infections, including causative agents and antimicrobial resistance patterns, in COVID-19 patients remain limited.
- Understanding these infections is crucial for effective treatment and reducing mortality.
Purpose of the Study:
- To determine the frequency of secondary bacterial infections in intensive care unit (ICU) patients with COVID-19.
- To identify common bacterial species causing these infections.
- To assess the antimicrobial resistance profiles of isolated pathogens.
Main Methods:
- Retrospective analysis of microbiological data from COVID-19 patients admitted to the ICU.
- Examination of tracheal aspirate, blood, and urine cultures collected at least 2 days post-ICU admission.
- Identification of bacterial species and susceptibility testing.
Main Results:
- Bacterial growth was detected in 33.3% of 369 analyzed cultures from 514 ICU patients.
- Secondary infections, including respiratory and bloodstream infections, occurred in 21% of patients.
- Common pathogens included Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, with significant resistance to multiple antibiotics, except for specific agents like colistin and meropenem.
Conclusions:
- Findings provide insights into the prevalence and resistance patterns of secondary bacterial infections in critically ill COVID-19 patients.
- This data can guide empirical antibiotic selection, potentially improving treatment outcomes and reducing mortality.
- Highlights the need for ongoing surveillance of antimicrobial resistance in the context of viral pandemics.
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