Microb Drug Resist . Respiratory Bacterial and Fungal Superinfections During the Third Surge of the COVID-19 Pandemic in Iran

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Microb Drug Resist


. 2023 Jan 4.
doi: 10.1089/mdr.2022.0227. Online ahead of print.
Respiratory Bacterial and Fungal Superinfections During the Third Surge of the COVID-19 Pandemic in Iran


Maryam Mobarak Qamsari ¹ , Leyla Sahebi ² , Mohammad Reaz Salehi ³ , Zohre Labbani-Motlagh ⁴ , Mehrdad Shavandi ⁴ , Neda Alijani ⁵ , Shahideh Amini ⁶ , Salma Sefidbakht ⁷ , Mohammad Mehdi Feizabadi ^{1 8}



Affiliations

• PMID: 36603057
• DOI: 10.1089/mdr.2022.0227

Abstract

Objective: We characterized bacterial and fungal superinfection and evaluated the antimicrobial resistance profile against the most common superinfection-causing pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus). Methods: In a cross-sectional study, 192 respiratory samples were collected from patients with and without SARS-COV-2 admitted to a teaching hospital in Tehran. Superinfection proportions and the antibiotic resistance profile were assessed and compared with demographic, comorbidities, and other clinical factors. Results: Superinfection rate was 60% among COVID-19 patients (p = 0.629). Intensive care unit admission (p = 0.017), mortality rate (p ≤ 0.001), and antiviral and corticosteroid therapy (p ≤ 0.001) were significantly more common among patients with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). The most common superinfections were caused by K. pneumoniae (42.7%, 82/192), A. baumannii (14.6%, 28/192), and S. aureus (13%, 25/192). A. baumannii isolates exhibited greater antibiotic resistance. Forty-four percent (11/25) of S. aureus isolates were cefoxitin resistant and also confirmed as methicillin-resistant S. aureus by PCR. Conclusion: The rise of difficult-to-treat infections with a high burden of antibiotic resistance, coupled with an increase in mortality rate of SARS-COV-2 superinfected individuals, illustrates the impact of the COVID-19 pandemic on antimicrobial resistance. Post-pandemic antimicrobial resistance crisis management requires precise microbiological diagnosis, drug susceptibility testing, and prescription of antimicrobials appropriate for the patient's condition.

Keywords: COVID-19 pandemic; antimicrobial resistance; respiratory infections; superinfection.