Antimicrobial resistance patterns of bacterial and fungal lower respiratory tract infections among COVID-19 patients and their impact on Mortality

Abstract

Background: Secondary infections and antibiotic resistance pattern in COVID-19 patients have drawn attention. Patients who were infected with COVID-19 were prone to subsequent infections. Aim of this work was to study the profile and antimicrobial susceptibility patterns of secondary bacterial and fungal lower respiratory tract infections in confirmed COVID-19 patients and analyse their impact on mortality. Patients and methods: From May to October 2022, 128 sputum and endotracheal aspirates samples were collected from hospitalized confirmed COVID-19 patients suspected of having bacterial and/or fungal secondary infection. The etiologic agents and antimicrobial resistance profiles were identified using conventional and Vitek 2 methods. Results: Out of the 128 collected samples, 103 samples were cultivated; eighty four samples revealed growth of pathogenic micro-organisms, in which Gram negative bacteria were prevalent accounting for 50% of pathogens detected. Klebsiella pneumoniae was the predominant pathogen detected, followed by Streptococcus pneumoniae accounting for about (23.8% and 15.5%) respectively . The majority of bacteria detected were resistance to more than two classes of antibiotics. However almost, no resistance was detected among Candida strains. Mortality among COVID-19 patients was significantly associated with older age, positive RT-PCR results for SARS-COV-2 at the time of secondary infection, and infection with drug resistant organisms. Conclusion: Gram-negative bacterial infections account for the majority of secondary infections in COVID-19 cases, and exhibit high rates of resistance to different categories of antimicrobials agents. Additionally the high mortality rate in patients with secondary infections necessitates special vigilance in improving infection control procedures and antimicrobial stewardship strategies.