Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 13:10:1113969.
doi: 10.3389/fmolb.2023.1113969. eCollection 2023.

Super-infection by multiple microorganisms in COVID-19 patients

Andrea C Gomez  1 , Tamin Ortiz  2 , Angélica Valenzuela  2 , Rocío Egoávil-Espejo  3 , Rosario Huerto-Huanuco  3 , Joseph A Pinto  1 , Jose Lagos  2 , Joaquim Ruiz  3
Affiliations

Super-infection by multiple microorganisms in COVID-19 patients

Andrea C Gomez et al. Front Mol Biosci. .

Abstract

Introduction: This study aimed to describe the clinical characteristics of patients with COVID-19 co-infected with multiple multidrug-resistant bacteria. Methods: Patients hospitalized in the AUNA network between January and May 2021, diagnosed with COVID-19 and at least two other infecting microorganisms, were retrospectively included in the analysis. Clinical and epidemiological data were extracted from clinical records. The susceptibility levels of the microorganisms were determined using automated methods. Antibiotic resistance was established among infecting bacteria accounting for ≥5 isolates. Results: A total of 27 patients (21 male and 6 female patients) met the inclusion criteria, with a maximum of eight co-infecting bacteria or fungi during admission time. Seven patients (25.9%) died, with a higher but not significant lethality among women (50% vs. 19.0%). A total of 15 patients presented at least one established comorbidity, with hypertension being the most frequent. The time elapsed between COVID-19 diagnosis and hospital attendance was 7.0 days, with that of patients with a fatal outcome being longer than that of living patients (10.6 vs. 5.4). Up to 20 different microorganisms were isolated, with Pseudomonas aeruginosa being the most common (34 isolates). In general, antibiotic resistance levels were high, especially in Acinetobacter baumannii isolates, with resistance levels of 88.9% to all antimicrobial agents tested, except colistin (0%). Conclusion: In conclusion, the present results show the presence of multiple microorganisms that co-infect COVID-19 patients. When fatal outcome rates are in the range of other reports, the presence of a series of multidrug-resistant microorganisms is of concern, showing the need to reinforce control measures to limit the expansion of almost untreatable microorganisms.

Keywords: COVID-19; Latin America; antimicrobial resistance; co-infection; hospitalization time.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Timeline of the infections.
FIGURE 2
FIGURE 2
Type of samples used for the diagnosis of patients.
FIGURE 3
FIGURE 3
Microorganisms isolated in hospitalized COVID-19 patients with multiple infections.
FIGURE 4
FIGURE 4
Microorganisms isolated during the three coinfection events. All Klebsiella pneumoniae strains belonging to the ssp. pneumoniae.
FIGURE 5
FIGURE 5
Antimicrobial resistance levels in Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. CTX, cefotaxime; CAZ, ceftazidime; FEP, cefepime; SAM, ampicillin plus sulbactam; TZP, piperacillin plus tazobactam; IMP, imipenem; MEM, meropenem; ERT, ertapenem; GEN, gentamicin; AMK, amikacin; CIP, ciprofloxacin; TGC, tigecycline; COL, colistin; ESBL, extended spectrum β-lactamases.
See this image and copyright information in PMC

References

    1. Alcedo K., Ruiz J., Ochoa T. J., Riveros M. (2022). High prevalence of bla CTX-M in fecal commensal Escherichia coli from healthy children. Infect. Chemother. 54, 59–69. 10.3947/ic.2021.0102 - DOI - PMC - PubMed
    1. Barrientos-Young R., Hinojosa-Salas B. A., Salas-Ponce P. G., Angles E., Ruiz J., Pons M. J. (in press). High rates of extensively-resistant Acinetobacter baumannii in aPeruvian hospital 2013-2019. Trop Doct. 10.1177/00494755221142939 - DOI - PubMed
    1. Bhatt N., Nepal S., Pinder R. J., Lucero-Prisno D. E., Budhathoki S. S. (2022). Challenges of hospital oxygen management during the COVID-19 pandemic in rural Nepal. Am. J. Trop. Med. Hyg. 106, 997–999. 10.4269/ajtmh.21-0669 - DOI - PMC - PubMed
    1. Brodin P. (2021). Immune determinants of COVID-19 disease presentation and severity. Nat. Med. 27, 28–33. 10.1038/s41591-020-01202-8 - DOI - PubMed
    1. Clinical and Laboratory Standards Institute (2017). Performance standards for antifungal susceptibility testing of yeasts. Supplement M60. Wayne: CLSI.