Profile of Bacterial Infections in COVID-19 Patients: Antimicrobial Resistance in the Time of SARS-CoV-2

Abstract

The global onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infections happened suddenly, hence imposing a rapid definition of effective therapeutic approaches. Antibiotics were included among the prophylactic agents because of both the similarity between SARS-CoV-2 and atypical pneumonia symptoms, and the immune-modulating and anti-inflammatory properties of such drugs. Although, this approach could exacerbate the emergence of antimicrobial resistance. To evaluate the impact of the COVID-19 pandemic on the spread and characteristics of bacterial infections, as well as on the frequency of antimicrobial resistance, we investigated and compared clinical bacterial strains isolated in an Italian hospital from COVID-19 patients and non-COVID-19 patients during and before the COVID-19 outbreak. Data clearly indicate the impact of the COVID-19 pandemic on bacterial infections: not only some bacterial species were found in either COVID-19 positive or in COVID-19 negative patients, but isolates from COVID-19 patients also showed higher levels of antimicrobial resistance. Nevertheless, despite some bacterial species were isolated only before or over the pandemic, no differences were observed among the antimicrobial resistance levels. Overall, these results recapitulate the current situation of microbial infections and could also provide an overview of the impact of COVID-19 on bacterial pathogens spread and resistance.

Multidrug resistant bacterial infections in severely ill COVID-19 patients admitted in a national referral and teaching hospital, Kenya

“…We found that the male COVID-19 patients were signi cantly at risk of bacterial infection as compared to female patients, and this is consistent with other studies that found men to be at risk of having bacterial infections, consequently being severely ill and at increased risk of death Gram-negative bacteria (GNB) isolates were susceptible to Amikacin (AMK) but not Gentamicin (GEN), as opposed to Stephanini et al (2020), who reported high resistance to amikacin among COVID-19 patients [47]. Aminoglycosides contain a defensin-mediated antiviral activity that, through retrocyclins, boosts immunity against SARS-CoV-2 [69].…”

“…[36], Egypt [45], Bahrain [46]and Italy [47]. The predominance of K. pneumoniae and GNB infections in COVID-19 patients is attributable to the microorganisms' ability to acquire different resistance traits [46] and to cause infections in patients with invasive devices and mechanical ventilation during hospitalization [47].…”

“…[36], Egypt [45], Bahrain [46]and Italy [47]. The predominance of K. pneumoniae and GNB infections in COVID-19 patients is attributable to the microorganisms' ability to acquire different resistance traits [46] and to cause infections in patients with invasive devices and mechanical ventilation during hospitalization [47]. The bacterial isolates pro le was not a typical representation of the conventional community-acquired but rather nosocomial infections, suggesting low co-infections at the time of admission.…”

“…In this study, GNB resistant to beta-lactamase inhibitor-containing antibiotics, thirdgeneration cephalosporins (cefotaxime and ceftriaxone), and fourth-generation cephalosporins, cefepime, were isolated. All these antibiotics are used in severe pneumonia management, with a possibility of overprescription, hence limiting their e cacy [47]. Acinetobacter calcoaceticus was resistant to all antibiotic classes, a phenomenon also observed in Italy among COVID-19 patients [47] and also in the general population [ [70][71].…”

Bacterial and Fungal Co-Infections and Superinfections in a Cohort of COVID-19 Patients: Real-Life Data from an Italian Third Level Hospital

“…To fight the inflammatory syndrome, many immunomodulant agents are used, such as corticosteroids, anti-interleukin-1 (IL-1), anti-interleukin-6 (IL-6), and inhibitors of the JAK-STAT pathway [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. The use of immune suppressive drugs, combined with the natural immune suppression caused by the virus, can lead to a surge of secondary bacterial and fungal infections [ 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”