A Prospective, Single Center, Investigator Initiated Observational Study for Identification of Bacterial Coinfections in COVID-19 Positive Patients with Respiratory Dysfunction and Severe Pneumonia Symptoms

This study aimed to assess bacterial co-infections in patients diagnosed with positive COVID-19 with respiratory dysfunction and severe pneumonia symptoms admitted in intensive care unit (ICU) of tertiary care hospital. This research was an observational study performed on 166 clinical bacterial isolates obtained from sputum, blood, urine of 20 critically ill COVID-19 positive patients diagnosed by RT PCR technique. Pathogens included were 82 Gram-negative and 84 Gram-positive clinical isolates. Antibiotic susceptibility was determined by broth MIC method. Among Gram-negative organisms, carbapenem resistance was found to be 54.55%, 33.33%, 93.33% in Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, respectively. Cefepime/zidebactam was found to be most active antibacterial agent tested. In Gram-positive isolates S. aureus and Enterococcus sp. were the most encountered isolates. Against Enterococcus sp. linezolid, daptomycin, vancomycin, tigecycline showed 100% susceptibility. For S. aureus, levonadifloxacin (WCK 771) was found to be most active antibiotic with 100% susceptibility followed by linezolid, teicoplanin. Presence of β-lactamases was confirmed by polymerase chain reaction (PCR) for blaTEM, blaSHV, blaCTX-M, blaNDM, blaCMY, blaOXA-48-like. In E. coli, NDM was most encountered β-lactamase whereas in K. pneumoniae, ESBL were predominantly detected. Dual carbapenemase i.e. NDM and OXA-48 like observed in K. pneumoniae. Most of the P. aeruginosa showed presence of OXA-4 and VEB type β-lactamase presence. Study clearly demonstrated early determination of co-infections and need of developing targeted antibacterial therapy as the highest priority. Findings showed presence of β-lactamases in bacterial pathogens that render the antibiotic resistant characteristics which significantly affect the clinical outcome and recovery of COVID-19 positive patients. Hence, it has become an urgent need to discover new antibiotics.