Abstract
Simple SummarySince the beginning of COVID-19 pandemic, no specific drugs have been available to treat the SARS-CoV-2 infection, therefore antibiotics have been often used both for prophylactic and therapeutic purposes. Their wide use, though, is known to contribute to the emergence of antimicrobial resistance. Aiming at evaluating the impact of the COVID-19 pandemic on the distribution and characteristics of bacterial infections, and on the frequency of antimicrobial resistance, we investigated the microbial strains identified through laboratory tests on clinical specimens from COVID-19 and non-COVID-19 patients accessing an Italian tertiary hospital over nearly one year. We highlighted that COVID+ patients bore a significantly higher number of bacterial species. Eight out of the 100 species identified were isolated exclusively from COVID+ and most of them are known to establish infections only in immunocompromised patients. Resistance to every tested antibiotic was seen in 8.3% of the isolates with a correlation with the positivity to COVID, but neither all COVID+ or COVID− isolates showed characteristic responses to the tested antibiotics. The predicted increase of antibiotic resistance is not observable yet, but the higher frequency of multi-resistant COVID+ isolates suggests that it is actually occurring, further calling for the definition of alternative treatments of COVID-19 infections.The global onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infections happened suddenly, hence imposing a rapid definition of effective therapeutic approaches. Antibiotics were included among the prophylactic agents because of both the similarity between SARS-CoV-2 and atypical pneumonia symptoms, and the immune-modulating and anti-inflammatory properties of such drugs. Although, this approach could exacerbate the emergence of antimicrobial resistance. To evaluate the impact of the COVID-19 pandemic on the spread and characteristics of bacterial infections, as well as on the frequency of antimicrobial resistance, we investigated and compared clinical bacterial strains isolated in an Italian hospital from COVID-19 patients and non-COVID-19 patients during and before the COVID-19 outbreak. Data clearly indicate the impact of the COVID-19 pandemic on bacterial infections: not only some bacterial species were found in either COVID-19 positive or in COVID-19 negative patients, but isolates from COVID-19 patients also showed higher levels of antimicrobial resistance. Nevertheless, despite some bacterial species were isolated only before or over the pandemic, no differences were observed among the antimicrobial resistance levels. Overall, these results recapitulate the current situation of microbial infections and could also provide an overview of the impact of COVID-19 on bacterial pathogens spread and resistance.
Highlights
The sudden, massive, and rapid spread of the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus (COVID-19) has demanded the adoption of drastic actions to contain the further spread of the infection and to rapidly adjust healthcare systems and frameworks
The number of bacterial strains isolated per month from COVID+ patients did correlate with the number of new COVID-19 patients observed at the national level [27] (Pearson r = 0.96, p = 4.62 × 10−6, Figure 1b)
The number of bacterial strains isolated per month from COVID− patients did not correlate with the number of new COVID-19 patients (Pearson r = −0.41, p = 0.214) nor with the number of bacterial strains isolated from COVID+ patients (Pearson r = −0.26, p = 0.436) (Figure 1b)
Summary
The sudden, massive, and rapid spread of the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus (COVID-19) has demanded the adoption of drastic actions to contain the further spread of the infection and to rapidly adjust healthcare systems and frameworks. In Italy, where the first domestic case was detected on 28 February 2020, early epidemic phases caught the National Healthcare System unprepared for such an event and a severe health crisis was averted by a rigid lockdown from 9 March to 3 May 2020, followed by a period of mitigation. Considering the urgency to alleviate the symptoms and resolve the infection, treatments are being experimentally defined [3]. The symptoms of COVID-19 infection are highly similar to atypical bacterial pneumonia [4,5,6] and this lead to the empirical decision to administer antimicrobials commonly used for the treatment of bacterial/fungal pneumonia in 72% of cases, worldwide, either to prevent the onset of concurrent infections or to exacerbate already present concomitant bacterial or fungal infections, despite microbial co-infections being observed only in 8% of COVID-infected patients [7]. Antibiotics could be useful in the treatment of COVID-19 positive patients because of their immune-modulating, anti-inflammatory, and potential antiviral properties [8] has to be considered, the antiviral effectiveness of some antibiotics (aminoglycosides and meropenem) [9,10] has not been proven yet or has been proven to be limited (fluoroquinolones) [11]
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