Incidence of Co-infection and its Impact on COVID-19 Patients admitted in the Intensive Care Unit

ABSTRACT

Background

Viral-bacterial co-infections are one of the most serious medical issues, with higher fatality rates. Few investigations have studied bacterial superinfections in individuals with coronavirus disease 2019 (COVID-19). Hence, we carried out the current research to assess the different types of secondary bacterial and fungal infections and their response to antibiotics and antifungals that affect COVID-19 patients’ outcomes when admitted to the intensive care unit (ICU).

Methods

A total of 65 COVID-19 patients admitted to the ICU were studied in this cross-sectional study. Endotracheal aspirate or sputum samples and blood samples were collected using strict infection control procedures. The bacterial isolates were identified using gram staining, growth characteristics, and standard biochemical reactions with antimicrobial susceptibility testing. Fungal infections were determined by serological assays.

Results

The incidence of bacterial co-infection was 47.7%. Death was significantly higher among COVID-19 patients with secondary infection (P < 0.001). The clinical isolates were 34, of which 31 (91.18%) were bacteria and 3 (8.82%) were fungi. Klebsiella pneumonia and Acinetobacter baumannii were the predominant gram-negative bacteria; representing 38% and 17.65%, respectively. Staphylococcus aureus was the predominant isolated gram-positive bacteria represented 11.76%. Candida albicans were the predominantly isolated fungi. Tigecycline and amikacin were the most sensitive antibiotics for associated bacterial co-infection of COVID-19 cases (80.6% and 70.9%, respectively). Flucytosine, amphotericin B, caspofungin, and micafungin were all found to be sensitive against candida Albicans isolates.

Conclusions

Mortality was significantly higher among COVID-19 patients with secondary bacterial and fungal co-infection. Klebsiella pneumonia and Acinetobacter baumannii were the most common co-infecting agents. Tigecycline and amikacin displayed the highest sensitivity patterns.

KEYWORDS:

• COVID‐19
• co-infection
• antibiotic
• ICU

Author’s contributions

Fatma Rageh, Shaymaa Abdelraheem, Mohamed A. Sakr, and Shimaa A. Al-Touny shared in Idea conceptualization and writing the protocol

Aiman Al-Touny, Eman Riad, Shimaa A. Al-Touny shared in data collection

Mohamed A. Sakr, Shaymaa Abdelraheem, and Rasha Elgamal revised lab results and supervised the cultures

Samar Ahmed performed statistical and data analysis and integrated the results into the manuscript.

All authors reviewed the literature and wrote the first drafts of respective sections of the manuscript.

Aiman Al-Touny, Fatma Rageh, Mohamed A. Sakr, and Shimaa A. Al-Touny integrated the sections and formed the final version

All authors read and approved the final manuscript.

Acknowledgments

Thanks to the ICU team

Sponsors and funding sources

All the research cost is afforded by authors

Disclosure statement

None