COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective
Kamaleldin B Said1,2,3, Ahmed Alsolami4, Safia Moussa5
1Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia.
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.
Insights
Bacterial co-infections significantly increase COVID-19 mortality. Multidrug-resistant bacteria like Klebsiella pneumoniae and Acinetobacter baumannii were common, especially in older patients, impacting treatment strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Bacterial co-infections can worsen COVID-19 outcomes.
- Understanding co-infecting pathogens is crucial for effective COVID-19 management.
- Antimicrobial resistance is a growing concern in hospital-acquired infections.
Purpose of the Study:
- To investigate the types, frequency, and antimicrobial resistance patterns of bacterial co-infections in COVID-19 patients.
- To determine the impact of co-infections on case fatality rates (CFR) and clinical profiles.
- To analyze the association between specific bacterial pathogens, infection sites, and patient demographics.
Main Methods:
- Retrospective analysis of 301 COVID-19 patients.
- Identification and characterization of co-infecting bacterial pathogens.
- Assessment of antibiograms, CFR, and clinical data, including patient age and infection site.
Main Results:
- Co-infection prevalence was 36%, with a significantly higher CFR (31.2%) compared to non-co-infected patients (9.9%).
- Dominant pathogens included multidrug-resistant Klebsiella pneumoniae (37%) and extremely drug-resistant Acinetobacter baumannii (26%).
- Co-infections were more frequent in seniors (≥50 years, 71%) and associated with higher mortality for K. pneumoniae and A. baumannii.
Conclusions:
- Bacterial co-infections, particularly with Gram-negative resistant organisms, significantly elevate COVID-19 mortality.
- Age is a critical factor, with elderly patients being more susceptible to co-infections.
- Findings highlight the need for targeted antimicrobial strategies and vigilant monitoring in COVID-19 patients, especially the elderly.
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