Prevalence and Antibiotic Resistance Profile of Secondary Bacterial Pneumonia and Bloodstream Infection Among Hospitalized COVID-19 Patients and Their Relation to Procalcitonin

Abstract

Background and Objectives: in COVID-19 patients, secondary bacterial infections (SBIs) are a known
complication of viral respiratory infections and are significantly associated with poorer outcomes.Our study
aimed to determine the prevalence, clinical profile, antimicrobial resistance profile, and patient outcomes of
secondary bacterial pneumonia and blood infections in COVID-19 hospitalized patients and their correlation
with procalcitonin (PCT) levels.
Method: During 7 months’ study, 260 clinical samples (blood and respiratory specimens) were collected from
130 hospitalized COVID-19 patients, of which 90 were from intensive care units (ICUs) and 40 from non-ICU
departments, at six hospitals in Erbil city, Iraq. All samples were applied for bacterial identification via
traditional method, Vitek-2 compact system, and molecular (PCR) detection. The antibiotic resistance profile
was obtained via Vitek-2 compact system and the Standard International Kirby-Bauer disc diffusion method.
Finally, the inflammatory biomarkers (PCT, C-reactive protein CRP, and WBC count) were evaluated.
Results: Among 130 patients, 64.16% were positive for SBIs, of which 86.9% from the ICU and 13.1% from
the non-ICU department. The most prevalent isolates were gram-negative (77.7%) versus gram-positive
(22.3%) bacteria. Klebsiella pneumoniae, Acinetobacter baumannii, and coagulase-negative staphylococci
were the predominant isolates in both blood and respiratory specimen. There was an obvious relation between
mortality rate and SBIs in the studied patients, which reached 81%. Most of the isolated bacteria, especially
ICU isolates, were multidrug resistant. PCT increased in 79 (89.8%) of the patients with SBIs. The highest PCT
level was found in patients with bloodstream infection.
Conclusion: There is a high prevalence of bacterial superinfections in COVID-19 patients during
hospitalization. Gram negative bacteria, especially Klebsiella pneumoniae and Acinetobacter baumannii were
the main bacteria, and the antimicrobial resistance rates against the major isolated bacteria were generally
high. The PCT level was positively associated with secondary bacterial infection and patient outcome.