EVALUATION OF BACTERIAL AND FUNGAL AGENTS ISOLATED FROM PATIENTS ADMITTED TO INTENSIVE CARE UNITS BEFORE AND DURING THE COVID-19 PANDEMIC AND COMPARISON OF ANTIBIOTIC SUSCEPTIBILITIES

Year 2024, Volume: 25 Issue: 1 - OCAK 2024 SAYISI, 86 - 93, 17.01.2024

Melahat Gürbüz , Emek Türkekul Şen , Berrin Esen

https://doi.org/10.18229/kocatepetip.1235556

Abstract

OBJECTIVE: The COVID-19 pandemic has created a global public health crisis. Intensive Care Unit (ICU) patients with COVID-19 are more prone to bacterial and fungal infections due to various risk factors. We aimed to analyze the isolated factors of antibiotic consumption in the ICU by comparing the antibiotic use profile and trends in microbiological isolates before and after the COVID-19 pandemic.
MATERIAL AND METHODS: Various clinical samples sent to the laboratory from ICU patients hospitalized during the COVID-19 period between March 2020 - February 2021 and before the COVID-19 period between March 2019-February 2020 were retrospectively analyzed. Etiological agents of bacterial and fungal infections were identified using the Vitek 2 identification method.
RESULTS: A total of 733 samples were included in this study, comprising 666 samples from the 1-year period before COVID-19 and 67 samples of patients with symptoms consistent with COVID-19 during the SARS-CoV-2 pandemic and positive PCR test. In the one-year period before the pandemic, the most frequently isolated agent was Klebsiella pneumoniae with 23.5%, followed by Pseudomonas aeruginosa at 17.7% and Acinetobacter baumannii at 16.8%. During the first one-year period of the pandemic, the most frequently isolated agent was Acinetobacter baumannii at 35.8%, unlike the pre-COVID-19 period. This was followed respectively by Klebsiella pneumoniae at 16.4% and predominantly Gram-positive agents.
CONCLUSIONS: The prevalence of concomitant bacterial/fungal infections and the diversity of agents in COVID 19 patients are unknown. We think that the comparison of the agents and their susceptibilities detected in this patient group with those detected in previous years will be useful in guiding empirical treatment.

Keywords

COVID-19, Coinfection, Antimicrobial resistance, SARS-CoV-2, Intensive care unit.

Project Number

yok

COVID-19 ÖNCESİ DÖNEMDE VE COVID-19 PANDEMİSİ SIRASINDA YOĞUN BAKIMDA YATAN HASTALARDAN İZOLE EDİLEN BAKTERİYEL VE FUNGAL ETKENLERİN DEĞERLENDİRİLMESİ VE ANTİBİYOTİK DUYARLILIKLARININ KARŞILAŞTIRILMASI

Abstract

AMAÇ: COVID-19 salgını, küresel bir halk sağlığı krizi yarattı. COVID-19'lu yoğun bakım hastaları, çeşitli risk faktörleri nedeniyle bakteriyel ve mantar kaynaklı enfeksiyonlara daha yatkındır. COVID-19 pandemisi öncesi ve sonrasında antibiyotik kullanım profili ve mikrobiyolojik izolatlardaki eğilimleri karşılaştırarak Yoğun Bakım Ünitesindeki (YBÜ) antibiyotik tüketimini izole edilen etkenleri analiz etmeyi amaçladık.
GEREÇ VE YÖNTEM: Mart 2020 - Şubat 2021 tarihleri arasında COVID-19 döneminde ve Mart 2019 - Şubat 2020 tarihleri arasında COVID-19 dönemi öncesinde hastaneye yatırılan YBÜ hastalarından laboratuvara gönderilen çeşitli klinik örnekler retrospektif olarak incelendi. Kültürde saptanan bakteriyel ve fungal etkenler Vitek 2 tanımlama yöntemi kullanılarak tanımlandı.
BULGULAR: Bu çalışmaya COVID-19 öncesi 1 yıllık süre içerisindeki 666 ve SARS-CoV-2 pandemisi sırasındaki COVID-19 ile uyumlu semptomları olan ve PCR testi pozitif çıkan 67 hasta örneği olmak üzere toplamda 733 örnek dahil edilmiştir. Pandemi öncesindeki bir yıllık dönemde en sık izole edilen etken %23,5 ile Klebsiella pneumoniae iken bunu %17,7 ile Pseudomonas aeruginosa ve %16,8 ile Acinetobacter baumannii izlediği görülmüştür. Pandeminin ilk bir yıllık dönemi boyunca en sık izole edilen etken, COVID-19 öncesi dönemin aksine, %35,8 ile Acinetobacter baumannii olmuştur. Bunu sırasıyla % 16,4 ile Klebsiella pneumoniae ve büyük oranda Gram pozitif etkenler takip etmiştir.
SONUÇ: COVID 19 hastalarında eşlik eden bakteriyel/fungal enfeksiyonların prevalansı ve etkenlerin çeşitliliği bilinmemektedir. Bu hasta grubunda saptanan etkenlerin ve duyarlılıklarının önceki yıllarda saptananlarla karşılaştırılmasının ampirik tedaviyi yönlendirmekte fayda sağlayacağını düşünmekteyiz.

Keywords

COVID-19, Koenfeksiyon, Antimikrobiyal direnç, SARS-CoV-2, Yoğun bakım ünitesi

Supporting Institution

yok

Project Number

yok

Thanks

Çalışma verilerinin toplanması ve işlenmesi aşamasındaki destekleri için Arş. Gör. Cengiz Demir'e teşekkür ederiz.

References

• 1. Centers for Disease Control and Prevention (2021). Antibiotic Resistance Threatens. https://www.cdc.gov/drugresistance/index.html, Erişim Tarihi: 20.12.2022.
• 2. Da Silva RMR, de Mendonça SCB, Leão IN et al. Use of monitoring indicators in hospital management of antimicrobials. BMC infectious diseases. 2021;21(1):1-8.
• 3. Fair RJ, Tor Y. Antibiotics and Bacterial Resistance in the 21st Century. Perspect. Medicin Chem. 2014;6:25–64.
• 4. Chung DR, Huh K. Novel pandemic influenza A (H1N1) and community-associated methicillin-resistant Staphylococcus aureus pneumonia. Expert Rev Anti Infect Ther. 2015;13(2):197-207.
• 5. Ng TM, Tan SH, Heng ST, et al. Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore. Antimicrob Resist Infect Control. 2021;10(1):1-8.
• 6. Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine. 2020;46(5):846-8.
• 7. Zhu X, Ge Y, Wu T, et al. Co-infection with respiratory pathogens among COVID-2019 cases. Virus Research. 2020;285:198005.
• 8. Rawson TM, Moore LSP, Zhu N, et al. Bacterial and fungal co-infection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71(9):2459–68.
• 9. World Health Organization. World Health Organization; 2020. Clinical Management of COVID-19: Interim Guidance, 27 May 2020. https://apps.who.int/iris/bitstream/handle/10665/332196/WHO-2019-nCoV- clinical-2020.5-eng.pdf?sequence=1&isAllowed=y, Erişim Tarihi: 15.12.2022.
• 10. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 11.0, 2021, Erişim Tarihi: 15.10.2022.
• 11. Reid AH, Fanning TG, Hultin JV, et al. Origin and evolution of the 1918 “Spanish” influenza virus hemagglutinin gene. Proc Natl Acad Sci Unit States Am. 1999;96:1651–6.
• 12. MacIntyre CR, Chughtai AA, Barnes M, et al. The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a (H1N1) pdm09. BMC Infect Dis. 2018;18:637.
• 13. Manna S, Baindara P, Mandal SM. Molecular pathogenesis of secondary bacterial infection associated to viral infections including SARS-CoV-2. Journal of Infection and Public Health. 2020;13(10):1397-1404.
• 14. Memish ZA, Perlman S, Van Kerkhove MD, et al. Middle East respiratory syndrome. Lancet. 2020;395(10229):1063–77.
• 15. Morens DM, Taubenberger JK, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis. 2008;198:962–70.
• 16. Klein EY, Monteforte B, Gupta A, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta analysis. Influenza and Other Respiratory Viruses. 2016;10:394–403.
• 17. Kaul D, Rathnasinghe R, Ferres M, et al. Microbiome disturbance and resilience dynamics of the upper respiratory tract during influenza A virus infection. Nat. Commun. 2020;11:1–12.
• 18. Lehmann CJ, Pho MT, Pitrak D, et al. Community acquired co-infection in COVID-19: a retrospective observational experience. Clin Infect Dis. 2020;72(8):1450–2.
• 19. Fu Y, Yang Q, Xu M, et al. Secondary bacterial infections in critical ill patients of COVID-19. Open Forum Infectious Diseases. 2020;7(6): ofaa220.
• 20. Zhang G, Hu C, Luo L, et al. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020:104364.
• 21. Lai CC, Wang CY, Hsueh PR. Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents? J. Microbiol. Immunol. Infect. 2020;53(4):505–12.
• 22. Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26:1622-9.
• 23. Russell CD, Fairfield CJ, Drake TM, et al. Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe 2021;2:354-65.
• 24. Sathyakamala R, Peace AR, Shanmugam P. A Comparative Study on Bacterial Co-Infections and Prevalence of Multidrug Resistant Organisms among Patients in COVID and Non-COVID Intensive Care Units. J Prev Med Hyg. 2022;26:63(1):19-26.
• 25. Li J, Wang J, Yang Y, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis. Antimicrob Resist Infect Control. 2020;9:153.
• 26. Mahmoudi H. Bacterial co-infections and antibiotic resistance in patients with COVID-19. GMS Hyg Infect Control. 2020;15:Doc35.
• 27. Sreenath K, Batra P, Vinayaraj EV, et al. Coinfections with other respiratory pathogens among patients with COVID-19. Microbiol Spectr. 2021;9:e0016321.
• 28. Arcari G, Raponi G, Sacco F, et al. Klebsiella pneumoniae infections in COVID-19 patients: a 2-month retrospective analysis in an Italian hospital. Int J Antimicrob Agents. 2021;57:106245.
• 29. Qu J, Cai Z, Liu Y, et al. Persistent Bacterial Coinfection of a COVID-19 Patient Caused by a Genetically Adapted Pseudomonas aeruginosa Chronic Colonizer. Front Cell Infect Microbiol. 2021;11:641920.
• 30. White PL, Dhillon R, Cordey A, et al. A national strategy to diagnose coronavirus disease 2019–associated invasive fungal disease in the intensive care unit. Clinical Infectious Diseases. 2021;73(7):1634-44.