Spectrum of Bacterial Co-Infections of the Lower Respiratory Tract in COVID 19 Patients Admitted to the ICU of a Tertiary Care Hospital

Abstract

Aims: We aimed to evaluate the burden of bacterial co-infections in patients with COVID-19 and to ensure judicious use of antibiotics. Study Design: Hospital based, cross sectional study. Place and Duration of Study: Postgraduate department of Microbiology, Government Medical College, Srinagar, and associated hospitals, between July 2020 and February 2021. Methodology: A total of 70 patients diagnosed with COVID-19 by RT PCR of nasopharyngeal/oropharyngeal samples were included in the study. Lower respiratory specimen like endotracheal aspirate (ETA), sputum, and bronchoalveolar lavage (BAL) from COVID-19 patients admitted in the ICU were collected as per standard protocol and subjected to quantitative cultures in the laboratory. Antimicrobial susceptibility testing was carried out in line with CLSI recommendations. Results: Of the 70 lower respiratory tract specimens (Endotracheal aspirate n=53, sputum n=15, and Bronchoalveolar lavage n=02) taken from RT-PCR confirmed COVID-19 patients, 51 (72.9%) showed microbiological evidence of bacterial infection by culture positivity. 28/51 (55%) were males and 23/51 (45%) were females, mean age was 54 years (range= 16-85 years). Majority of the organisms recovered (n=51, 83%) were Gram-negative bacilli, among which Acinetobacter spp. (n=27, 53%) followed by Klebsiella pneumoniae (n=06, 12%) were the most common. Among Gram positive organisms, methicillin resistant Staphylococcus aureus and Enterococcus sp were most commonly isolated. Conclusion: It is evident from our study that superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus is of serious concern. Timely treatment of these infections is pivotal to decrease the morbidity and mortality rates in COVID-19-infected patients.