Infection and Drug Resistance (Jun 2021)

Coinfections in Patients Hospitalized with COVID-19: A Descriptive Study from the United Arab Emirates

  • Senok A,
  • Alfaresi M,
  • Khansaheb H,
  • Nassar R,
  • Hachim M,
  • Al Suwaidi H,
  • Almansoori M,
  • Alqaydi F,
  • Afaneh Z,
  • Mohamed A,
  • Qureshi S,
  • Ali A,
  • Alkhajeh A,
  • Alsheikh-Ali A

Journal volume & issue
Vol. Volume 14
pp. 2289 – 2296

Abstract

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Abiola Senok,1,* Mubarak Alfaresi,2,* Hamda Khansaheb,3 Rania Nassar,1,4 Mahmood Hachim,1 Hanan Al Suwaidi,1 Majed Almansoori,2 Fatma Alqaydi,2 Zuhair Afaneh,2 Aalya Mohamed,2 Shahab Qureshi,2 Ayman Ali,2 Abdulmajeed Alkhajeh,3 Alawi Alsheikh-Ali1,3 1College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates; 2Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates; 3Dubai Health Authority, Dubai, United Arab Emirates; 4Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, UK*These authors contributed equally to this workCorrespondence: Abiola SenokCollege of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, PO Box 505055, Dubai, United Arab EmiratesTel +971-4-383-8717Email [email protected]: Microbial coinfections in COVID-19 patients carry a risk of poor outcomes. This study aimed to characterize the clinical and microbiological profiles of coinfections in patients with COVID-19.Methods: A retrospective review of the clinical and laboratory records of COVID-19 patients with laboratory-confirmed infections with bacteria, fungi, and viruses was conducted. Only adult COVID-19 patients hospitalized at participating health-care facilities between February 1 and July 31, 2020 were included. Data were collected from the centralized electronic system of Dubai Health Authority hospitals and Sheikh Khalifa General Hospital Umm Al Quwain.Results: Of 29,802 patients hospitalized with COVID-19, 392 (1.3%) had laboratory-confirmed coinfections. The mean age of patients with coinfections was 49.3± 12.5 years, and a majority were male (n=330 of 392, 84.2%). Mean interval to commencement of empirical antibiotics was 1.2± 3.6) days postadmission, with ceftriaxone, azithromycin, and piperacillin–tazobactam the most commonly used. Median interval between admission and first positive culture (mostly from blood, endotracheal aspirates, and urine specimens) was 15 (IQR 8– 25) days. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli were predominant in first positive cultures, with increased occurrence of Stenotrophomonas maltophilia, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Candida auris, and Candida parapsilosis in subsequent cultures. The top three Gram-positive organisms were Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus. There was variability in levels of sensitivity to antibiotics and isolates harboring mecA, ESBL, AmpC, and carbapenemase-resistance genes were prevalent. A total of 130 (33.2%) patients died, predominantly those in the intensive-care unit undergoing mechanical ventilation or extracorporeal membrane oxygenation.Conclusion: Despite the low occurrence of coinfections among patients with COVID-19 in our setting, clinical outcomes remained poor. Predominance of Gram-negative pathogens, emergence of Candida species, and prevalence of isolates harboring drug-resistance genes are of concern.Keywords: SARS-CoV2, microbial coinfections, clinical outcomes, Pseudomonas, Candida

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