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. 2022 Apr 26;19(9):5270.
doi: 10.3390/ijerph19095270.

COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria

Kamaleldin B Said  1   2   3 , Ahmed Alsolami  4 , Safia Moussa  5 , Fayez Alfouzan  5 , Abdelhafiz I Bashir  6 , Musleh Rashidi  7 , Rana Aborans  8 , Taha E Taha  9 , Husam Almansour  10 , Mashari Alazmi  11 , Amal Al-Otaibi  1 , Luluh Aljaloud  1 , Basmah Al-Anazi  1 , Ahmed Mohialdin  12 , Ahmed Aljadani  4
Affiliations

COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria

Kamaleldin B Said et al. Int J Environ Res Public Health. .

Abstract

Bacterial co-infections may aggravate COVID-19 disease, and therefore being cognizant of other pathogens is imperative. We studied the types, frequency, antibiogram, case fatality rates (CFR), and clinical profiles of co-infecting-pathogens in 301 COVID-19 patients. Co-infection was 36% (n = 109), while CFR was 31.2% compared to 9.9% in non-co-infected patients (z-value = 3.1). Four bacterial species dominated, namely, multidrug-resistant Klebsiella pneumoniae (37%, n = 48), extremely drug-resistant Acinetobacter baumannii (26%, n = 34), multidrug-resistant Eschericia. coli (18.6%, n = 24), and extremely drug-resistant Pseudomonas aeruginosa (8.5%, n = 11), in addition to other bacterial species (9.3%, n = 12). Increased co-infection of K. pneumoniae and A. baumannii was associated with increased death rates of 29% (n = 14) and 32% (n = 11), respectively. Klebsiella pneumoniae was equally frequent in respiratory and urinary tract infections (UTI), while E. coli mostly caused UTI (67%), and A. baumannii and P. aeruginosa dominated respiratory infections (38% and 45%, respectively). Co-infections correlated with advance in age: seniors ≥ 50 years (71%), young adults 21-49 years (25.6%), and children 0-20 years (3%). These findings have significant clinical implications in the successful COVID-19 therapies, particularly in geriatric management. Future studies would reveal insights into the potential selective mechanism(s) of Gram-negative bacterial co-infection in COVID-19 patients.

Keywords: SARS-CoV-2 pandemic; empirical-antimicrobial therapy; mortality; nosocomial resistance; selective infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Antimicrobial sensitivity patterns of K. pneumoniae clinical isolates against 21 antibiotics. Abbreviations (in the order in which they appear in the figure): AK, amikacin; AUG, amoxicillin/clavulanic acid (2/1); AMC ampicillin*/sulbactam (2/1); ATM, aztreonam; FEP, cefepime; FOX, cefoxitin; CAZ, ceftazidime; CRO, ceftriaxone; CXM, cefuroxime; KF, cephalothin; CIP, ciprofloxacin; CS, colistin; ETP, ertapenem; CN, gentamicin; IMI, imipenem; LEV, levofloxacin; MRP, meropenem; NIT, nitrofurantoin; TZP, tazobactam; TGC, tigecycline; SXT, trimethoprim/sulfamethoxazole.
Figure 2
Figure 2
Antimicrobial sensitivity patterns of A.baumanii clinical isolates against 21 antibiotics. Abbreviations (in the order in which they appear in the figure): AK, amikacin; AUG, amoxicillin/clavulanic acid (2/1); AMC ampicillin; ATM, aztreonam; FEP, cefepime; FOX, cefoxitin; CAZ, ceftazidime; CRO, ceftriaxone CXM, cefuroxime; KF, cephalothin; CIP, ciprofloxacin; CS, colistin; ETP, ertapenem; CN, gentamicin; IMI, imipenem; LEV, levofloxacin; MRP, meropenem; NIT, nitrofurantoin; TZP, tazobactam; TGC, tigecycline; SXT, trimethoprim/sulfamethoxazole.
Figure 3
Figure 3
Antimicrobial sensitivity patterns of E. coli clinical isolates against 21 antibiotics. Abbreviations (in the order in which they appear in the figure): AK, amikacin; AUG, amoxicillin/clavulanic acid (2/1); AMC, ampicillin; ATM, aztreonam; FEP, cefepime; FOX, cefoxitin; CAZ, ceftazidime; CRO, ceftriaxone; CXM, cefuroxime; KF, cephalothin; CIP, ciprofloxacin; CS, colistin; ETP, ertapenem; CN, gentamicin; IMI, imipenem; LEV, levofloxacin; MRP, meropenem; NIT, nitrofurantoin; TZP, tazobactam; TGC, tigecycline; SXT, trimethoprim/sulfamethoxazole.
Figure 4
Figure 4
Antimicrobial sensitivity patterns of P. aeruginosa clinical isolates against 21 antibiotics. Abbreviations (in the order in which they appear in the figure): AK, amikacin; AUG, amoxicillin/clavulanic acid (2/1); AMC, ampicillin; ATM, aztreonam; FOX, cefoxitin; CAZ, ceftazidime; CRO, ceftriaxone; CXM, cefuroxime; KF, cephalothin; CIP, ciprofloxacin; CS, colistin; ETP, ertapenem; CN, gentamicin; IMI, imipenem; LEV, levofloxacin; MRP, meropenem; NIT, nitrofurantoin; TZP, tazobactam; TGC, tigecycline; SXT, trimethoprim/sulfamethoxazole.
Figure 5
Figure 5
Antimicrobial sensitivity patterns of “other” Gram-negative bacterial clinical isolates against 21 antibiotics.
Figure 6
Figure 6
Overall COVID-19 case fatality rate in 301 patients with and without secondary bacterial co-infections in the Ha’il region, Saudi Arabia.
See this image and copyright information in PMC

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