Selective COVID-19 Coinfections in Diabetic Patients with Concomitant Cardiovascular Comorbidities Are Associated with Increased Mortality

Abstract

Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates (p-value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.

Keywords: COVID-19 aggravation; Gram-negative coinfections; coinfections; comorbidity.

Figure 1

(a) Case fatality rates of diabetes in coinfected COVID-19 patients; (b) Frequency of bacterial species in diabetic COVID-19 patients; (c) Recovery and death rates among diabetic COVID-19 patients coinfected with different bacterial species.

Figure 2

(a) Case fatality rates of hypertension in coinfected COVID-19 patients; (b) Recovery and death rates among hypertensive COVID-19 patients coinfected with different bacterial species.

Figure 3

(a) Case fatality rates of ischemic heart disease in coinfected COVID-19 patients; (b) Recovery and death rates among ischemic heart COVID-19 patients coinfected with different bacterial species.

Figure 4

(a) Case fatality rates of asthma in coinfected COVID-19 patients; (b) Recovery and death among asthmatic COVID-19 patients coinfected with different bacterial species.

Figure 5

(a) Case fatality rates of chronic kidney diseases (CKD) in coinfected COVID-19 patients; (b) Recovery and death among COVID-19 patients with CKD and coinfected with different bacterial species.

Figure 6

(a) Case fatality rates among coinfected COVID-19 patients with and without chronic liver disease; (b) Recovery and death among COVID-19 patients with chronic liver disease coinfected with different bacterial species.