Procalcitonin Level and Antimicrobial Resistance among Microbial Coinfection in Hospitalized COVID-19 Patients

Hospitalized Coronavirus Disease 2019 (COVID-19) patients are at a higher risk of bacterial and fungal infections. Procalcitonin is an inflammatory marker that has been suggested for distinguishing between bacterial and viral infections that predicting bacterial co-infection in COVID-19 and serving as a helpful indicator for determining the severity of the illness. This study aimed to evaluate procalcitonin levels and antimicrobial resistance (AMR) among microbial co-infections in hospitalized COVID-19 patients.

Clinical and microbiological data were obtained from the medical records of 100 COVID-19 patients.

COVID-19 patients with bacterial infections had a 55% mortality rate. The majority of microbial cultures were detected in blood (49%), sputum (44%), and urine (7%). Among the isolates, 57.7% were Gram-negative bacteria, 31.7% were Gram-positive bacteria, 6.7% were mixed isolates, and 3.8% were fungal isolates. The predominant Gram-negative isolates were Klebsiella pneumoniae (37.2%), Acinetobacter baumannii (20.2%), and Streptococcus pneumoniae (14.4%). Candida albicans (2.9%) was the most commonly isolated fungal pathogen, followed by Aspergillus spp. (1%). Most of the isolates showed high resistance to broad-spectrum antibiotics. Gram-negative bacteria were detected in 29% of COVID-19 patients who died, Gram-positive bacteria in 20%, and mixed bacteria in 6%. The majority of surviving patients had procalcitonin levels below 0.25 ng/mL, whereas non- survivors had higher levels.

Secondary microbial infections in COVID-19 patients remain a critical concern during the pandemic. Additionally, multidrug-resistant organisms are an increasing challenge. In hospitalized COVID-19 patients, baseline procalcitonin levels were associated with patient outcomes and bacterial coinfection.