Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis

Abstract

Background A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired secondary bacterial infections (SBIs). The etiology and antimicrobial resistance of bacteria were reported and used to provide a theoretical basis for appropriate infection therapy. Methods This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 27 and March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. Results Among 1495 patients hospitalized with COVID-19, 102 (6.8%) patients had acquired SBIs, and almost half of them (49.0%, 50/102) died during hospitalization. Compared with severe patients, critical patients had a higher chance of SBIs. Among the 159 strains of bacteria isolated from the SBIs, 136 strains (85.5%) were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%, 57/159), K. pneumoniae (30.8%, 49/159), and S. maltophilia (6.3%, 10/159). The isolation rates of carbapenem-resistant A. baumannii and K. pneumoniae were 91.2 and 75.5%, respectively. Meticillin resistance was present in 100% of Staphylococcus aureus and Coagulase negative staphylococci, and vancomycin resistance was not found. Conclusions SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the severity of illness on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. This was a single-center study; thus, our results should be externally examined when applied in other institutions.

Antimicrobial susceptibility patterns of respiratory Gram-negative bacterial isolates from COVID-19 patients in Switzerland

“…The etiology found here for late-onset VABP in COVID-19 patients resembles the diversity of Gramnegative pathogens typically found in nosocomial pneumonia [25]. Previous cohort studies have reported diverse etiology in COVID-19 confirmed cohorts, with A. baumannii, K. pneumoniae, E. coli and P. aeruginosa as predominant infecting agents [26][27][28]. The species distribution and resistance pattern within individual studies may vary depending on the geographic and local ICU etiology of resistant isolates, study-specific patient recruitment and sample selection, and the treatment history of prior antibiotic exposure in regular VABP patients and COVID-19 patients.…”

Clinical Characteristics and Outcome of Patients With Severe COVID-19 Pneumonia at a Public Sector Hospital in Karachi, Pakistan

“…Subcutaneous emphysema was a significant complication, also described in other studies, and has been associated with a poor prognosis [ 21 ]. Most of our patients with subcutaneous emphysema were on NIV, and interestingly, only two had concomitant pneumothorax.…”

Potential Applications of Conducting Polymers to Reduce Secondary Bacterial Infections among COVID-19 Patients: a Review

“…Studies on the interplay between SARS-CoV-2 and type I IFNs confirmed that SARS-Cov-2 infection inhibits type I IFNs production and signaling which increases susceptibility of the host toward secondary bacterial infections [ 67 , 68 ]. The infections include bloodstream infections that are normally caused by coagulase-negative staphylococci, Acinetobacter baumannii , Escherichia coli , [ 69 ], Klebsiella pneumoniae , and Stenotrophomonas maltophilia [ 70 ]. Other viruses that caused respiratory diseases such as rhinovirus and influenza virus also show increased secondary invasion of the airway epithelium lining by pathogenic bacteria and worsening disease progression [ 71 ].…”