Skip to content
2000
Volume 25, Issue 4
  • ISSN: 1871-5265
  • E-ISSN: 2212-3989

Abstract

Background

COVID-19 patient hospitalization, particularly in intensive care units, exposes them to bacterial and fungi co-infections, which can have very serious consequences, including increased mortality. In addition, antibiotic resistance among pathogens is a hidden threat behind COVID-19.

Methods

In the period from 2020 September to 2021 August, bacterial isolates from COVID-19 patients admitted to the ICU of Sina Hospital in Hamadan, Iran, were collected and identified based on standard biochemical tests. COVID-19 cases were confirmed based on clinical symptoms, computed tomography, and polymerase chain reaction. Antimicrobial susceptibility tests were conducted using disc diffusion and broth microdilution methods.

Results

In total, 207 bacterial isolates were collected, with accounting for 69 (33.33%) and accounting for 59 (28.15%). The frequency and percentage of isolated bacteria were as species 28 (13.59%), 18 (8.73%), 15 (7.28%), 11 (5.33%), 3 (1.45%), species 3 (1.45%), and species 1 (0.48%). About 95.38% resistance to ceftazidime and cefotaxime and 92.31% resistance to ciprofloxacin and cefepime were found in isolates. isolates were 100% resistant to cefotaxime, ceftriaxone, and cefepime. About 22.22% resistance to vancomycin and 66.67% resistance to clindamycin, erythromycin, and cefoxitin were seen in isolates.

Conclusion

Knowledge of bacterial co-infections and their antibiotic resistance pattern in COVID-19 patients can help in choosing effective antibiotics for the treatment and prevention of antibiotic resistance.

Loading

Article metrics loading...

/content/journals/iddt/10.2174/0118715265338445241007092436
2024-11-08
2025-09-03
Loading full text...

Full text loading...

References

  1. ChenN. ZhouM. DongX. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.Lancet20203951022350751310.1016/S0140‑6736(20)30211‑7 32007143
    [Google Scholar]
  2. GuanW. NiZ. HuY. Clinical characteristics of coronavirus disease 2019 in China.N. Engl. J. Med.2020382181708172010.1056/NEJMoa2002032 32109013
    [Google Scholar]
  3. CiottiM. CiccozziM. TerrinoniA. JiangW.C. WangC.B. BernardiniS. The COVID-19 pandemic.Crit. Rev. Clin. Lab. Sci.202057636538810.1080/10408363.2020.1783198 32645276
    [Google Scholar]
  4. BhattT. KumarV. PandeS. MalikR. KhampariaA. GuptaD. A review on COVID-19.Studies in Computational Intelligence2021924254210.1007/978‑3‑030‑60188‑1_2 32982622
    [Google Scholar]
  5. SalianV.S. WrightJ.A. VedellP.T. COVID-19 transmission, current treatment, and future therapeutic strategies.Mol. Pharm.202118375477110.1021/acs.molpharmaceut.0c00608 33464914
    [Google Scholar]
  6. ShereenM.A. KhanS. KazmiA. BashirN. SiddiqueR. COVID-19 infection: Emergence, transmission, and characteristics of human coronaviruses.J. Adv. Res.202024919810.1016/j.jare.2020.03.005 32257431
    [Google Scholar]
  7. MorawskaL. TangJ.W. BahnflethW. How can airborne transmission of COVID-19 indoors be minimised?Environ. Int.202014210583210.1016/j.envint.2020.105832 32521345
    [Google Scholar]
  8. JarvisM.C. Aerosol transmission of SARS-CoV-2: physical principles and implications.Front. Public Health2020859004110.3389/fpubh.2020.590041 33330334
    [Google Scholar]
  9. ArumugamV.A. ThangaveluS. FathahZ. COVID-19 and the world with co-morbidities of heart disease, hypertension and diabetes.J. Pure Appl. Microbiol.20201431623163810.22207/JPAM.14.3.01
    [Google Scholar]
  10. Al HeialyS. HachimM.Y. HachimI.Y. Combination of obesity and co-morbidities leads to unfavorable outcomes in COVID-19 patients.Saudi J. Biol. Sci.20212821445145010.1016/j.sjbs.2020.11.081 33293887
    [Google Scholar]
  11. VermaP. ChaudharyS. KaurS. MidhaT. MartoliaD.S. Impact of co-morbidities in COVID -19 infected patients.Indian J. Community Health2022341262910.47203/IJCH.2022.v34i01.006 33344064
    [Google Scholar]
  12. JindalR. GuptaM. KhanF.R. ChaudhryG. Prevalence of co-morbidities and its association with mortality in Indian patients with COVID-19: A meta-analysis.Indian J. Anaesth.202266639941810.4103/ija.ija_845_21
    [Google Scholar]
  13. PanggaribuanS.M. YeminaL. WidiastutiS.H. PurboriniN. CasmanC. Associated Factors of Loneliness Among Adolescents in Indonesia during the Pandemic of Covid-19.Jurnal Berita Ilmu Keperawatan2024171364710.23917/bik.v17i1.2979
    [Google Scholar]
  14. BellaB. PangaribuanS.M. WidiastutiS.H. Stress and Sleep Quality among the Elderly During The COVID-19 Pandemic: A cross-sectional study.Jurnal Berita Ilmu Keperawatan2023161112110.23917/bik.v16i1.1260
    [Google Scholar]
  15. KabakE. AuparaiN.S. HalotopoY. The Impact of Covid-19 on homecare workforce: an analytical review.Jurnal Berita Ilmu Keperawatan202316112513410.23917/bik.v16i1.1511
    [Google Scholar]
  16. LiQ. ZhangT. LiF. Acute kidney injury can predict in-hospital mortality in elderly patients with COVID-19 in the ICU: a single-center study.Clin. Interv. Aging2020152095210710.2147/CIA.S273720 33204075
    [Google Scholar]
  17. ArinaP. MoroV. BasoB. Baxter-DerringtonC. SingerM. Sepsis in severe COVID-19 is rarely septic shock: a retrospective single-centre cohort study.Br. J. Anaesth.20211275e182e18510.1016/j.bja.2021.08.007 34511259
    [Google Scholar]
  18. Koçak TufanZ. KayaaslanB. MerM. COVID-19 and Sepsis.Turk. J. Med. Sci.202151SI-13301331110.3906/sag‑2108‑239 34590796
    [Google Scholar]
  19. HeubnerL. HattenhauerS. GüldnerA. Characteristics and outcomes of sepsis patients with and without COVID-19.J. Infect. Public Health202215667067610.1016/j.jiph.2022.05.008 35617831
    [Google Scholar]
  20. LaiC.C. WangC.Y. HsuehP.R. Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?J. Microbiol. Immunol. Infect.202053450551210.1016/j.jmii.2020.05.013 32482366
    [Google Scholar]
  21. HuttnerB.D. CathoG. Pano-PardoJ.R. PulciniC. SchoutenJ. COVID-19: don’t neglect antimicrobial stewardship principles!Clin. Microbiol. Infect.202026780881010.1016/j.cmi.2020.04.024 32360446
    [Google Scholar]
  22. JosephC. TogawaY. ShindoN. Bacterial and viral infections associated with influenza.Influenza Other Respir. Viruses20137s2Suppl. 210511310.1111/irv.12089 24034494
    [Google Scholar]
  23. RiceT.W. RubinsonL. UyekiT.M. Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States.Crit. Care Med.20124051487149810.1097/CCM.0b013e3182416f23 22511131
    [Google Scholar]
  24. MulcahyM.E. McLoughlinR.M. Staphylococcus aureus and influenza a virus: partners in coinfection.MBio20167610
    [Google Scholar]
  25. CanningB. SenanayakeV. BurnsD. MoranE. DedicoatM. Post-influenza aspergillus ventriculitis.Clin. Infect. Pract.20207-810002610.1016/j.clinpr.2020.100026
    [Google Scholar]
  26. KhuranaS. SinghP. SharadN. Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: Implication on antimicrobial resistance.Indian J. Med. Microbiol.202139214715310.1016/j.ijmmb.2020.10.014 33966856
    [Google Scholar]
  27. ShiralizadehS KeramatF HashemiSH MajzoobiMM AzimzadehM AlikhaniMS Molecular typing and antimicrobial sensitivity of MDR-Pseudomonas aeruginosa isolated from Coronavirus disease-2019 patients.202310.21203/rs.3.rs‑2402818/v1
    [Google Scholar]
  28. CoxM.J. LomanN. BogaertD. O’GradyJ. Co-infections: potentially lethal and unexplored in COVID-19.Lancet Microbe202011e1110.1016/S2666‑5247(20)30009‑4 32835323
    [Google Scholar]
  29. ElabbadiA. TurpinM. GerotziafasG.T. TeulierM. VoiriotG. FartoukhM. Bacterial coinfection in critically ill COVID-19 patients with severe pneumonia.Infection202149355956210.1007/s15010‑020‑01553‑x 33393065
    [Google Scholar]
  30. PatelA. Tackling antimicrobial resistance in the shadow of COVID-19.MBio202112410
    [Google Scholar]
  31. García-MeniñoI. ForcelledoL. RoseteY. García-PrietoE. EscuderoD. FernándezJ. Spread of OXA-48-producing Klebsiella pneumoniae among COVID-19-infected patients: The storm after the storm.J. Infect. Public Health2021141505210.1016/j.jiph.2020.11.001 33341484
    [Google Scholar]
  32. PhuaJ. WengL. LingL. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations.Lancet Respir. Med.20208550651710.1016/S2213‑2600(20)30161‑2 32272080
    [Google Scholar]
  33. MirzaeiH. McFarlandW. KaramouzianM. SharifiH. COVID-19 among people living with HIV: a systematic review.AIDS Behav.2021251859210.1007/s10461‑020‑02983‑2 32734438
    [Google Scholar]
  34. SilvaA.R.O. SalgadoD.R. LopesL.P.N. CastanheiraD. EmmerickI.C.M. LimaE.C. Increased use of antibiotics in the intensive care unit during coronavirus disease (COVID-19) pandemic in a Brazilian hospital.Front. Pharmacol.20211277838610.3389/fphar.2021.778386 34955847
    [Google Scholar]
  35. MustafaL. TolajI. BaftiuN. FejzaH. Use of antibiotics in COVID-19 ICU patients.J. Infect. Dev. Ctries.202115450150510.3855/jidc.14404 33956649
    [Google Scholar]
  36. MalikS.S. MundraS. Increasing consumption of antibiotics during the COVID-19 pandemic: implications for patient health and emerging anti-microbial resistance.Antibiotics (Basel)20221214510.3390/antibiotics12010045 36671246
    [Google Scholar]
  37. GuleriaR. MohanA. KulkarniA. Guidelines for antibiotic prescription in intensive care unit.Indian J. Crit. Care Med.201923S1Suppl. 116310.5005/jp‑journals‑10071‑23101 31516211
    [Google Scholar]
  38. MusuuzaJ.S. WatsonL. ParmasadV. Putman-BuehlerN. ChristensenL. SafdarN. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis.PLoS One2021165e025117010.1371/journal.pone.0251170 33956882
    [Google Scholar]
  39. Conway MorrisA. KohlerK. De CorteT. Correction: Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set.Crit. Care202226124910.1186/s13054‑022‑04124‑8 35978317
    [Google Scholar]
  40. PaseroD. CossuA.P. TerragniP. Multi-drug resistance bacterial infections in critically ill patients admitted with COVID-19.Microorganisms202198177310.3390/microorganisms9081773 34442852
    [Google Scholar]
  41. MeawedT.E. AhmedS.M. MowafyS.M.S. SamirG.M. AnisR.H. Bacterial and fungal ventilator associated pneumonia in critically ill COVID-19 patients during the second wave.J. Infect. Public Health202114101375138010.1016/j.jiph.2021.08.003 34420902
    [Google Scholar]
  42. SorianoM.C. VaqueroC. Ortiz-FernándezA. CaballeroA. Blandino-OrtizA. de PabloR. Low incidence of co-infection, but high incidence of ICU-acquired infections in critically ill patients with COVID-19.J. Infect.2021822e20e2110.1016/j.jinf.2020.09.010 32956729
    [Google Scholar]
  43. WayneP. CLSI M100. Performance standards for antimicrobial susceptibility testing.2018Available from: https://clsi.org/standards/products/microbiology/documents/m100/ (accessed on 21-9-2024)
    [Google Scholar]
  44. CallenderL.A. CurranM. BatesS.M. MairesseM. WeigandtJ. BettsC.J. The impact of pre-existing comorbidities and therapeutic interventions on COVID-19.Front. Immunol.202011199110.3389/fimmu.2020.01991 32903476
    [Google Scholar]
  45. EjazH. AlsrhaniA. ZafarA. COVID-19 and comorbidities: Deleterious impact on infected patients.J. Infect. Public Health202013121833183910.1016/j.jiph.2020.07.014 32788073
    [Google Scholar]
  46. HarrisonA.G. LinT. WangP. Mechanisms of SARS-CoV-2 transmission and pathogenesis.Trends Immunol.202041121100111510.1016/j.it.2020.10.004 33132005
    [Google Scholar]
  47. YangJ. ZhengY. GouX. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis.Int. J. Infect. Dis.202094919510.1016/j.ijid.2020.03.017 32173574
    [Google Scholar]
  48. RamadanH.K.A. MahmoudM.A. AburahmaM.Z. Predictors of severity and co-infection resistance profile in COVID-19 patients: First report from upper Egypt.Infect. Drug Resist.2020133409342210.2147/IDR.S272605 33116660
    [Google Scholar]
  49. RichardsonS. HirschJ.S. NarasimhanM. CrawfordJ.M. McGinnT. DavidsonK.W. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.JAMA2020323202052205910.1001/jama.2020.6775
    [Google Scholar]
  50. JamnaniA.N. MontazeriM. MirzakhaniM. MoosazadehM. HaghighiM. Evaluation of bacterial coinfection and antibiotic resistance in patients with COVID-19 under mechanical ventilation.SN Compr. Clin. Med.2022411910.1007/s42399‑021‑01114‑9 35013721
    [Google Scholar]
  51. SharifipourE. ShamsS. EsmkhaniM. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU.BMC Infect. Dis.202020164610.1186/s12879‑020‑05374‑z 32873235
    [Google Scholar]
  52. BazaidA.S. BarnawiH. QanashH. Bacterial coinfection and antibiotic resistance profiles among hospitalised COVID-19 patients.Microorganisms202210349510.3390/microorganisms10030495 35336071
    [Google Scholar]
  53. SaeedN.K. Al-KhawajaS. AlsalmanJ. AlmusawiS. AlbalooshiN.A. Al-BiltagiM. Bacterial co-infection in patients with SARS-CoV-2 in the Kingdom of Bahrain.World J. Virol.202110416818110.5501/wjv.v10.i4.168 34367932
    [Google Scholar]
  54. MahmoudiH. Bacterial co-infections and antibiotic resistance in patients with COVID-19.GMS hygiene and infection control202010.3205/dgkh000370
    [Google Scholar]
  55. KreitmannL. MonardC. DauwalderO. SimonM. ArgaudL. Early bacterial co-infection in ARDS related to COVID-19.Intensive Care Med.20204691787178910.1007/s00134‑020‑06165‑5 32661615
    [Google Scholar]
  56. SepulvedaJ. WestbladeL.F. WhittierS. Bacteremia and blood culture utilization during COVID-19 surge in New York City.J. Clin. Microbiol.2020588e00875e2010.1128/JCM.00875‑20 32404482
    [Google Scholar]
  57. Garcia-VidalC. SanjuanG. Moreno-GarcíaE. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study.Clin. Microbiol. Infect.2021271838810.1016/j.cmi.2020.07.041 32745596
    [Google Scholar]
  58. BuettiN. RucklyS. de MontmollinE. COVID-19 increased the risk of ICU-acquired bloodstream infections: a case–cohort study from the multicentric OUTCOMEREA network.Intensive Care Med.202147218018710.1007/s00134‑021‑06346‑w 33506379
    [Google Scholar]
  59. PuzniakL. FinelliL. YuK.C. A multicenter analysis of the clinical microbiology and antimicrobial usage in hospitalized patients in the US with or without COVID-19.BMC Infect. Dis.202121122710.1186/s12879‑021‑05877‑3 33639862
    [Google Scholar]
  60. PalanisamyN. VihariN. MeenaD.S. Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study.BMC Infect. Dis.202121193310.1186/s12879‑021‑06647‑x 34496787
    [Google Scholar]
  61. OmoushS.A. AlzyoudJ.A.M. The prevalence and impact of coinfection and superinfection on the severity and outcome of COVID-19 infection: an updated literature review.Pathogens202211444510.3390/pathogens11040445 35456120
    [Google Scholar]
  62. SreenathK BatraP VinayarajE BhatiaR Coinfections with other respiratory pathogens among patients with COVID-19.Microbiol spect20219110
    [Google Scholar]
  63. GrecoR. PanettaV. Della RoccaM.T. DuranteA. Di CaprioG. MaggiP. Profile of co-infection prevalence and antibiotics use among COVID-19 patients.Pathogens20221111125010.3390/pathogens11111250 36365001
    [Google Scholar]
  64. SharmaB. SreenivasanP. BiswalM. Bacterial coinfections and secondary infections in COVID-19 patients from a tertiary care hospital of northern India: Time to adhere to culture-based practices.Qatar Med. J.2021202136210.5339/qmj.2021.62 34745914
    [Google Scholar]
  65. CohenR. BabushkinF. FinnT. High rates of bacterial pulmonary co-infections and superinfections identified by multiplex PCR among critically ill COVID-19 patients.Microorganisms2021912248310.3390/microorganisms9122483 34946086
    [Google Scholar]
  66. AttalR. DeotaleV. Bacterial co-infections and secondary infections and their antimicrobial resistance in COVID-19 patients during the second pandemic wave.GMS Hygiene and Infection Control202410.3205/dgkh000465
    [Google Scholar]
  67. LavrinenkoA. KolesnichenkoS. KadyrovaI. TurmukhambetovaA. AkhmaltdinovaL. KlyuyevD. Bacterial co-infections and antimicrobial resistance in patients hospitalized with suspected or confirmed COVID-19 pneumonia in Kazakhstan.Pathogens202312337010.3390/pathogens12030370 36986292
    [Google Scholar]
  68. LansburyL. LimB. BaskaranV. LimW.S. Co-infections in people with COVID-19: a systematic review and meta-analysis.J. Infect.202081226627510.1016/j.jinf.2020.05.046 32473235
    [Google Scholar]
  69. LangfordB.J. SoM. RaybardhanS. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis.Clin. Microbiol. Infect.202026121622162910.1016/j.cmi.2020.07.016 32711058
    [Google Scholar]
  70. GhoshS. BornmanC. ZaferM.M. Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand?J. Infect. Public Health202114555556010.1016/j.jiph.2021.02.011 33848884
    [Google Scholar]
  71. KnightG.M. GloverR.E. McQuaidC.F. Antimicrobial resistance and COVID-19: Intersections and implications.eLife202110e6413910.7554/eLife.64139 33588991
    [Google Scholar]
  72. SeatonR.A. GibbonsC.L. CooperL. Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals.J. Infect.202081695296010.1016/j.jinf.2020.09.024 32987097
    [Google Scholar]
  73. Mędrzycka-DąbrowskaW. LangeS. ZorenaK. DąbrowskiS. OzgaD. TomaszekL. Carbapenem-resistant Klebsiella pneumoniae infections in ICU COVID-19 Patients—A scoping review.J. Clin. Med.20211010206710.3390/jcm10102067 34066031
    [Google Scholar]
  74. PolemisM. MandilaraG. PappaO. COVID-19 and antimicrobial resistance: Data from the greek electronic system for the surveillance of antimicrobial resistance—WHONET-Greece (January 2018–March 2021).Life (Basel)2021111099610.3390/life11100996 34685368
    [Google Scholar]
  75. MarchaimD. ChopraT. PogueJ.M. Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan.Antimicrob. Agents Chemother.201155259359910.1128/AAC.01020‑10 21115786
    [Google Scholar]
  76. GasparG.G. TamascoG. AbichabkiN. Nosocomial outbreak of extensively drug-resistant (Polymyxin B and Carbapenem) Klebsiella pneumoniae in a collapsed university hospital due to COVID-19 Pandemic.Antibiotics202211681410.3390/antibiotics11060814 35740220
    [Google Scholar]
  77. RawsonT.M. MooreL.S.P. ZhuN. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing.Clin. Infect. Dis.2020719ciaa53010.1093/cid/ciaa530 32358954
    [Google Scholar]
  78. BillsC.B. NewberryJ.A. RaoG.V.R. Acute respiratory illness among a prospective cohort of pediatric patients using emergency medical services in India: Demographic and prehospital clinical predictors of mortality.PLoS One2020154e023091110.1371/journal.pone.0230911 32240227
    [Google Scholar]
  79. RuanQ. YangK. WangW. JiangL. SongJ. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China.Intensive Care Med.202046584684810.1007/s00134‑020‑05991‑x 32125452
    [Google Scholar]
/content/journals/iddt/10.2174/0118715265338445241007092436
Loading
/content/journals/iddt/10.2174/0118715265338445241007092436
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test