Frequency and antimicrobial resistance pattern of bacterial isolates from patients with COVID-19 in two hospitals of Zanjan

Narges Moradi; Niloufar Kazemi; Mehdi Ghaemi; Bahman Mirzaei

doi:10.18502/ijm.v13i6.8078

Narges Moradi Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran
Niloufar Kazemi Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran
Mehdi Ghaemi Department of Anestheiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Bahman Mirzaei Department of Medical Microbiology and Virology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran

DOI: https://doi.org/10.18502/ijm.v13i6.8078

Keywords: Bacterial co-infections; COVID-19; Susceptibility testing; SARS-CoV-2

Abstract

Background and Objectives: The outbreak of COVID-19 has been challenging the global health systems. As one of the major associated concerns, microbial co-infections and antimicrobial resistance play critical roles in the prognosis of the disease. This study aims to evaluate co-infections in COVID-19 patients regarding drug resistance.

Materials and Methods: A total number of 5530 Real Time PCR-confirmed COVID-19 cases, who were admitted to two major educational Hospitals in Zanjan, Iran, from February 2019 to February 2020 were included. Respiratory, blood and urine specimens were collected and cultured on selective media. Subsequently, isolates identification, disc diffusion suscep- tibility tests, and data analysis were carried out.

Results: Bacterial and fungal co-infections were confirmed in 423 patients (8.1%). Co-infections were more prevalent among females (53.2%) than males (46.8%). Coinfected patients had a significantly higher mortality rate compared to those without co-infections (54.8% vs. 12.2%, P<0.001). Acinetobacter baumannii was the most prevalent bacteria isolated from respiratory tract (15.4%) and blood (2.1%). Escherichia coli (12.5%) was the most frequent bacteria in urine. Fungal co-in- fection was confirmed in 174 (3.36%) patients. Gram-negative bacteria were highly sensitive to colistin (97.85%) and wide- ly resistant to cefixime (91.79%) and trimethoprim-sulfamethoxazole (89.64%). Gram-positive bacteria were considerably sensitive to vancomycin (68%) and nitrofurantoin (66%). Tetracycline and ampicillin were the least effective antibiotics for Gram-positive bacteria with respective resistance rates of 90.91% and 83.33%.

Conclusion: Given the high incidence of bacterial co-infections in COVID-19 patients, it is important to develop rapid and efficient diagnostic, therapeutic and disinfection guidelines to control these infections in the hospitals.