| Popis: |
Background: Despite multiple reports of increased incidence of bacterial respiratory tract infections following COVID-19 globally, the microbiology is not fully elucidated. In this study, we describe the incidence and microbiology of bacterial infections and the burden of multidrug resistant organisms (MDROs) in hospitalized COVID-19 patients with community-acquired pneumonia (CAP), non-ventilated hospital acquired pneumonia (NVHAP) or ventilator-associated pneumonia (VAP). To our knowledge, this is the first study that compares the microbiology of VAP and NVHAP in COVID-19 patients.Methods:This is a longitudinal retrospective cohort study conducted at the American University of Beirut Medical Center (AUBMC), a tertiary-care center in Lebanon. Adult patients with confirmed COVID-19 who were hospitalized between March 2020 and September 2021 were included. Only pathogens isolated within 42 days of positive SARS-CoV-2 tests were included. Bacterial isolates identified in hospital-acquired pneumonia (HAP) were divided into 3 groups based on the time of acquiring pneumonia after admission: hospital day 3-14, 15-28 and 29-42.Results:Out of 1674 patients admitted with COVID-19, 159 (9.5%) developed one or more respiratory infections. Overall, Gram-negative bacteria were predominant (83.5%) andS. maltophiliawas the most common pathogen (14.3%).S. aureusandHaemophilusspp. were implicated in most CAPs, whileK. pneumonia,S. maltophilia and E. coliwere the top culprits in HAP during hospital days 3-14, 15-28 and 29-42 respectively. Among 231 isolates obtained, 59 (25.5%) were MDROs, seen in higher proportion in HAP, especially among patients with prolonged hospital stay (> 4 weeks). Non-fermenter Gram-negative bacilli (NFGNB) (OR = 3.521, p-value = 0.000), particularlyS. maltophilia(OR = 3.236, p-value = 0.022), were significantly more implicated in VAP compared to NVHAP.Conclusions:COVID-19 patients hospitalized at AUBMC are at a slightly lower risk for bacterial respiratory infections compared to other studies. The pathogens varied according to the time since hospitalization. The burden of NFGNB and S.maltophiliais particularly high in COVID-19 VAP, indicating the need for further studies targeting these pathogens. A high rate of bacterial resistance was found which has important implications in guiding therapeutic decisions in COVID-19 patients who acquire bacterial infections. |
