مجله علوم پزشکی فیض (پیوسته) (Jun 2024)
Determination of bacterial co-infection and antibiotic sensitivity patterns in COVID-19 patients with ventilator-associated pneumonia (VAP) admitted to the intensive care unit of Shahid Beheshti Hospital in Kashan, Iran, during 2021-2022
Abstract
Background and Aim: Bacterial co-infections have emerged as significant contributors to mortality in patients with viral respiratory infections, particularly during the COVID-19 pandemic. This study aimed to determine the frequency of bacterial co-infections and the antibiotic sensitivity patterns of strains isolated from tracheal cultures of COVID-19 patients with ventilator-associated pneumonia (VAP) admitted to the intensive care unit (ICU). Methods: In this cross-sectional study, we examined 57 COVID-19 patients diagnosed with VAP by an infectious disease specialist at Shahid Beheshti Hospital in Kashan, Iran, during 2021-2022. Respiratory secretion samples were collected 48 hours after hospitalization. Following Gram staining, microbial tests and cultures were conducted on blood agar and MacConkey agar (MAC) media. The isolated bacterial colonies were identified using specific tests and cultivation in differential and selective media. Antibiotic susceptibility testing was performed according to CLSI guidelines, with sensitivity patterns determined using the agar diffusion method. Results: Among the 57 COVID-19 patients with VAP, 31 (54.4%) were women, and 77% of the patients died. Hypertension and diabetes were the most frequently reported underlying conditions. The predominant bacteria isolated from tracheal cultures were Acinetobacter (50.9%), Klebsiella (33.3%), and coagulase-negative Staphylococcus (7%). Antibiogram results revealed that Acinetobacter exhibited the highest resistance to cotrimoxazole, meropenem, piperacillin, tazobactam, and ciprofloxacin, while Klebsiella showed the greatest resistance to piperacillin, tazobactam, ceftriaxone, ciprofloxacin, and ceftazidime. Conclusion: The high prevalence of Gram-negative bacteria such as Klebsiella and Acinetobacter, along with significant antibiotic resistance in COVID-19 patients with VAP, poses a critical challenge for ICU personnel. Therefore, investigating the antimicrobial resistance of strains isolated from these patients can aid in timely treatment and rational antibiotic prescription.
