Determine phenotypical patterns of resistance to antibiotics in COVID-19 patients with associated bacterial infection: largest medical center in Iran

Esmaeil Mohammadnejad; Arash Seifi; Reza Ghanei Gheshlagh; Amir Aliramezani; Samrand  Fattah Ghazi; Mohammadreza Salehi; Seyed Ali Dehghan Manshadi; Amirhossein Orandi

doi:10.18502/ijm.v15i3.12893

Esmaeil Mohammadnejad Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Arash Seifi Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Reza Ghanei Gheshlagh Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
Amir Aliramezani Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
Samrand Fattah Ghazi Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Salehi Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Department of Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ali Dehghan Manshadi Department of Infectious Disease and Tropical Medicine, School of Medicine, Iranian Research Center for HIV/AID, Iranian Institute for reduction of High- Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
Amirhossein Orandi Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijm.v15i3.12893

Keywords: Pneumonia; COVID-19; Intensive care unit; Antimicrobial resistance; Surveillance

Abstract

Background and Objectives: Antibacterial resistance (AMR) is a serious threat and major concern, especially in developing countries. Therefore, we aimed to determine phenotypical patterns of resistance to antibiotics in COVID-19 patients with associated bacterial infection in intensive care units.

Materials and Methods: In this cross-sectional study, 6524 COVID-19 patients admitted for more than 48 h in the ICUs of Imam Khomeini Complex Hospital (IKCH) in Tehran from March 2020 to January 2022 were included in the study with initial diagnosis of COVID-19 (PCR test and chest imaging). Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, length of ICU and hospital stay, microbial type, and antibiotic resistance. In this study, the pattern of antibiotic resistance was determined using the Kirby–Bauer disk diffusion method.

Results: In this study, 439 (37.5%) were ventilator-related events (VAEs), and 46% of all hospitalized patients had an under- lying disease. The most common microorganisms in COVID-19 patients were carbapenem resistant Klebsiella pneumoniae (KPCs) (31.6%), Escherichia coli (E. coli) (15.8%), and Acinetobacter baumannii (A. baumannii) (15.7%), respectively. Prevalence of vancomycin-resistant enterococci (VRE) and KPCs were 88% and 82%, respectively.

Conclusion: A study on AMR surveillance is the need of the hour as it will help centers to generate local antibiograms that will further help formulate national data. It will guide doctors to choose the appropriate empiric treatment, and these studies will be the basis for establishing antimicrobial surveillance and monitoring and regulating of the use of antimicrobials.