Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients

Naveed Ahmed¹, Madiha Khan¹, Waqas Saleem¹, Mohmed Isaqali Karobari^{2

3}, Roshan Noor Mohamed⁴, Artak Heboyan⁵, Ali A Rabaan^{6

7

8}, Abbas Al Mutair⁹, Saad Alhumaid¹⁰, Salman A Alsadiq¹¹, Ahmed S Bueid¹², Eman Y Santali¹³, Jeehan H Alestad¹⁴

Affiliations

¹ Department of Microbiology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan.
² Center for Transdisciplinary Research (CFTR), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, Tamil Nadu, India.
³ Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh 12211, Cambodia.
⁴ Department of Pediatric Dentistry, Faculty of Dentistry, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
⁵ Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan 0025, Armenia.
⁶ Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia.
⁷ College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia.
⁸ Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan.
⁹ School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia.
¹⁰ Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia.
¹¹ Home Health Care Department, Ras Tanurah Hospital, Ras Tanurah 32817, Saudi Arabia.
¹² Microbiology Laboratory, King Faisal General Hospital, Al-Ahsa 31982, Saudi Arabia.
¹³ Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
¹⁴ Immunology and Infectious Microbiology, Glasgow G1 1XQ, UK.

PMID: 35203877
PMCID: PMC8868529
DOI: 10.3390/antibiotics11020276

Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients

Naveed Ahmed et al. Antibiotics (Basel). 2022.

. 2022 Feb 19;11(2):276.

doi: 10.3390/antibiotics11020276.

Authors

Affiliations

¹ Department of Microbiology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan.
² Center for Transdisciplinary Research (CFTR), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, Tamil Nadu, India.
³ Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh 12211, Cambodia.
⁴ Department of Pediatric Dentistry, Faculty of Dentistry, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
⁵ Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan 0025, Armenia.
⁶ Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia.
⁷ College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia.
⁸ Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan.
⁹ School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia.
¹⁰ Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia.
¹¹ Home Health Care Department, Ras Tanurah Hospital, Ras Tanurah 32817, Saudi Arabia.
¹² Microbiology Laboratory, King Faisal General Hospital, Al-Ahsa 31982, Saudi Arabia.
¹³ Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
¹⁴ Immunology and Infectious Microbiology, Glasgow G1 1XQ, UK.

PMID: 35203877
PMCID: PMC8868529
DOI: 10.3390/antibiotics11020276

Abstract

In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p < 0.05) was noted between the hospitalized COVID-19 patients and bacterial co-infections. Staphylococcus aureus (S. aureus) showed high resistance against tetracycline (61.7%), Streptococcus pyogenes against penicillin (100%), E. coli against Amp-clavulanic acid (88.72%), Klebsiella pneumoniae against ampicillin (100%), and Pseudomonas aeruginosa against ciprofloxacin (75.40%). Acinetobacter baumannii was 100% resistant to the majority of tested antibiotics. The prevalence of methicillin-resistant S. aureus (MRSA) was 14.7%. The topmost symptoms of >50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended.

Keywords: COVID-19; SARS-CoV-2; antimicrobial resistance; antimicrobial stewardship; co-infections; hospital-acquired infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Prevalence of bacterial co-infections in COVID-19 patients. MRSA: methicillin-resistant *S. aureus*; MSSA: methicillin-sensitive *S. aureus*.

**Figure 2**
Top 10 symptoms observed in COVID-19 patients vs. COVID-19 patients with bilateral co-infections.

See this image and copyright information in PMC

References

1. Bashir M.F., Jiang B., Komal B., Bashir M.A., Farooq T.H., Iqbal N., Bashir M. Correlation between environmental pollution indicators and COVID-19 pandemic: A brief study in Californian context. Environ. Res. 2020;187:109652. doi: 10.1016/j.envres.2020.109652. - DOI - PMC - PubMed
1. Li Q., Guan X., Wu P., Wang X., Zhou L., Tong Y., Ren R., Leung K.S., Lau E.H., Wong J.Y., et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N. Engl. J. Med. 2020;382:1199–1207. doi: 10.1056/NEJMoa2001316. - DOI - PMC - PubMed
1. Hendaus M.A., Jomha F.A. COVID-19 induced superimposed bacterial infection. J. Biomol. Struct. Dyn. 2020;39:4185–4191. doi: 10.1080/07391102.2020.1772110. - DOI - PubMed
1. Yeo A.J., Henningham A., Fantino E., Galbraith S., Krause L., Wainwright C.E., Sly P.D., Lavin M.F. Increased susceptibility of airway epithelial cells from ataxia-telangiectasia to S. pneumoniae infection due to oxidative damage and impaired innate immunity. Sci. Rep. 2019;9:2627. doi: 10.1038/s41598-019-38901-3. - DOI - PMC - PubMed
1. Baker M.A., Sands K.E., Huang S.S., Kleinman K., Septimus E.J., Varma N., Blanchard J., Poland R.E., Coady M.H., Yokoe D.S., et al. The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections. Clin. Infect. Dis. 2021;9:1–7. doi: 10.1093/cid/ciab688. - DOI - PMC - PubMed

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Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients

Affiliations

Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources