Reviewer response for version 1

Abstract

Introduction: Patients suffering from Coronavirus disease-2019 (COVID-19) are prone to develop respiratory bacterial infections irrespective of their need for mechanical ventilatory support. Hypothesis/Gap Statement: Information about the incidence of concomitant respiratory bacterial infections in COVID- 19 patients from India is limited. Aim: This study denotes the incidence of concomitant respiratory bacterial pathogens and their drug resistance in these patients. Methodology: A prospective study was performed by including the patients who were admitted to our tertiary care center from March 2021 to May 2021 to evaluate secondary bacterial respiratory co-infections in patients with Real-time polymerase chain reaction (RT-PCR) confirmed cases of COVID-19 disease caused by SARS CoV-2 virus. Results: Sixty-nine culture-positive respiratory samples from patients suffering from COVID-19 were incorporated into this study. The most commonly isolated bacterial microorganism was Klebsiella pneumoniae (23, 33.33%) and Acinetobacter baumannii (15, 21.73%), followed by Pseudomonas aeruginosa (13, 18.84%). Among the microorganisms isolated, 41 (59.4%) were multidrug-resistant (MDR), and 9 (13%) were extensively drug-resistant (XDR). Among the Gram-negative bacteria isolated, Klebsiella pneumoniae showed high drug resistance. Fifty carbapenem-resistant microorganisms were isolated from the patients included in our study. Concerning the hospital stay of the patients enrolled, there was an increased length of intensive care unit (ICU) stay, which was 22.25 ± 15.42 days among patients needing mechanical ventilation in comparison to 5.39 ± 9.57 days of intensive care unit stay in patients on ambient air or low/high flow oxygen. Conclusion: COVID-19 patients need increased length of hospitalization and have a high incidence of secondary respiratory bacterial infections and high anti-microbial drug resistance.