Bacterial Coinfection and Antibiotic Resistance Profiles among Hospitalised COVID-19 Patients

Abstract

While it is reported that COVID-19 patients are more prone to secondary bacterial infections, which are strongly linked to the severity of complications of the disease, bacterial coinfections associated with COVID-19 are not widely studied. This work aimed to investigate the prevalence of bacterial coinfections and associated antibiotic resistance profiles among hospitalised COVID-19 patients. Age, gender, weight, bacterial identities, and antibiotic sensitivity profiles were collected retrospectively for 108 patients admitted to the intensive care unit (ICU) and non-ICU ward of a single center in Saudi Arabia. ICU patients (60%) showed a significantly higher percentage of bacterial coinfections in sputum (74%) and blood (38%) samples, compared to non-ICU. Acinetobacter baumannii (56%) and Klebsiella pneumoniae (56%) were the most prevalent bacterial species from ICU patients, presenting with full resistance to all tested antibiotics except colistin. By contrast, samples of non-ICU patients exhibited infections with Escherichia coli (31%) and Pseudomonas aeruginosa (15%) predominantly, with elevated resistance of E. coli to piperacillin/tazobactam and trimethoprim/sulfamethoxazole. This alarming correlation between multi-drug resistant bacterial coinfection and admission to the ICU requires more attention and precaution with prescribed antibiotics to limit the spread of resistant bacteria and improve therapeutic management.

Keywords: Antimicrobial surveillance; COVID-19; antibiotics; multi-drug resistant bacteria; resistance.

Figure 1

The numbers of bacterial isolates identified in different types of samples collected from ICU and non-ICU COVID-19 patients; ** p < 0.01, *** p < 0.001.

Figure 2

The numbers of identified bacterial species isolated from COVID-19 patients admitted to (A) ICU and (B) non-ICU in different sample types (blood, sputum, urine, and wound swabs); * p < 0.05, *** p < 0.001, **** p < 0.0001.

Figure 3

Heat maps representing the percentages of antibiotic resistant bacteria in positive cultures isolated from samples collected from COVID-19 patients in (A) ICU and (B) non-ICU care.