COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria

Kamaleldin B. Said, Ahmed Alsolami, Safia Moussa, Fayez Alfouzan, Abdelhafiz I. Bashir, Musleh Rashidi, Rana Aborans, Taha E. Taha, Husam Almansour, Mashari Alazmi, Amal Al-Otaibi, Luluh Aljaloud, Basmah Al-Anazi, Ahmed Mohialdin and Ahmed Aljadani
Additional contact information
Kamaleldin B. Said: Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Ahmed Alsolami: Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Safia Moussa: Department of Microbiology, King Salman Specialist Hospital, Ha’il 55476, Saudi Arabia
Fayez Alfouzan: Department of Microbiology, King Salman Specialist Hospital, Ha’il 55476, Saudi Arabia
Abdelhafiz I. Bashir: Department of Physiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Musleh Rashidi: Ministry of Health, Hail Region, Ha’il 55476, Saudi Arabia
Rana Aborans: Department of Community Medicine, Faculty of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Taha E. Taha: Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Husam Almansour: Health Management Department, College of Public Health and Health Informatics, University of Ha’il, Ha’il 81481, Saudi Arabia
Mashari Alazmi: College of Computer Science and Engineering, University of Ha’il, Ha’il 81481, Saudi Arabia
Amal Al-Otaibi: Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Luluh Aljaloud: Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Basmah Al-Anazi: Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Ahmed Mohialdin: Department of Surgery, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia
Ahmed Aljadani: Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia

IJERPH, 2022, vol. 19, issue 9, 1-16

Abstract: Bacterial co-infections may aggravate COVID-19 disease, and therefore being cognizant of other pathogens is imperative. We studied the types, frequency, antibiogram, case fatality rates (CFR), and clinical profiles of co-infecting-pathogens in 301 COVID-19 patients. Co-infection was 36% ( n = 109), while CFR was 31.2% compared to 9.9% in non-co-infected patients (z-value = 3.1). Four bacterial species dominated, namely, multidrug-resistant Klebsiella pneumoniae (37%, n = 48), extremely drug-resistant Acinetobacter baumannii (26%, n = 34) , multidrug-resistant Eschericia. coli (18.6%, n = 24), and extremely drug-resistant Pseudomonas aeruginosa (8.5%, n = 11), in addition to other bacterial species (9.3%, n = 12). Increased co-infection of K. pneumoniae and A. baumannii was associated with increased death rates of 29% ( n = 14) and 32% ( n = 11), respectively. Klebsiella pneumoniae was equally frequent in respiratory and urinary tract infections (UTI), while E. coli mostly caused UTI (67%), and A. baumannii and P. aeruginosa dominated respiratory infections (38% and 45%, respectively). Co-infections correlated with advance in age: seniors ? 50 years (71%), young adults 21–49 years (25.6%), and children 0–20 years (3%). These findings have significant clinical implications in the successful COVID-19 therapies, particularly in geriatric management. Future studies would reveal insights into the potential selective mechanism(s) of Gram-negative bacterial co-infection in COVID-19 patients.

Keywords: SARS-CoV-2 pandemic; empirical-antimicrobial therapy; nosocomial resistance; selective infections; mortality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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