Co-infection of Uropathogenic Escherichia coli among COVID-19 Patients Admitted to a Tertiary Care Centre: A Descriptive Cross-sectional Study

Abstract

Introduction: Simultaneous infection of antibiotic-resistant uropathogens in patients with COVID-19 has necessitated the revision of the prescription of broad-spectrum antibiotics on the grounds of evidence-based studies and antimicrobial stewardship principles. The objective of this study was to find out the prevalence of uropathogenic Escherichia coli co-infection among hospital-admitted COVID-19 patients of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in urinary tract infection suspected COVID-19 patients admitted to a tertiary care hospital, from 25th June to 24th December 2021 after ethical clearance from the Institutional Review Committee with registration number 207707860. Convenience sampling was used. Serum procalcitonin levels were also measured. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data, and mean and standard deviation for continuous data. Results: Among the 49 hospital-admitted COVID-19 patients, 3 (6.12%) (0.59-12.83 at 95% Confidence Interval) were co-infected with uropathogenic Escherichia coli. Absolute non-susceptibility of Escherichia coli to antibiotics such as ceftriaxone, cotrimoxazole, nalidixic acid, gentamicin, and ampicillin was observed. All isolates were multidrug-resistant. All co-infected patients were female and had a median age of 35 years. Mean±SD value for procalcitonin in patients with co-infection (6.13±7.88 ng/ml) was six times higher than for the patients without co-infection (0.95±1.11 ng/ml). Conclusions: Escherichia coli co-infection in hospitalised COVID-19 patients was less frequent as compared to published literature. The serum procalcitonin value in patients with co-infection was substantially higher than that of patients without co-infection.

Procalcitonin as a Tool to Antimicrobial Stewardship in COVID-19 Patients with Superimposed Bacterial Infections: A Systematic Review

“… Richards et al 3 None Procalcitonin (>50% of baseline) is an indicator of bacterial coinfection in COVID-19 patients. Basnet et al 12 None Procalcitonin is an indicator of bacterial coinfection in COVID-19 patients. He et al 6 None Increased procalcitonin levels does not rule in bacterial co-infection; however, low procalcitonin levels can rule out bacterial co-infection and limit antibiotic use.…”

Multiple microbial coinfections occurred during COVID-19 pandemic

“…Bacterial germs such as Escherichia coli, Haemophilus influenza, Klebsiella pneumonia, Legionella pneumophila, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis can invade damaged lung tissue and cause secondary bacterial pneumonia. [8][9][10][11] There are several others that greatly affect the situation during the pandemic (Table 1A). This can exacerbate respiratory problems and increase the likelihood that something bad will happen.…”