Co-infections In COVID-19 Patients Research Articles

Looking into mucormycosis coinfections in COVID-19 patients using computational analysis

<abstract> <p>Mucormycosis infection may develop after using steroids treatment to improve the severely of the symptoms in coronavirus patients. The rising in the infection rate of mucormycosis has been noticed in patients after COVID-19 infection. To understand the high morbidity mucormycosis coinfection, the cell surface Glucose Regulated Protein 78 (CS-GRP78) was docked to the virus ACE2-SARS-CoV-2 RBD to create the ACE2-SARS-CoV-2 RBD-GRP78 complex which facilitates the virus entrance into the cell. The spore coat protein homolog 3 (CotH3) of mucormycosis was modeled and docked to the ACE2-SARS-CoV-2 RBD-GRP78 complex. The binding energies of CotH3 with RBD, ACE2, and GRP78 were calculated. The binding results show that GRP78 substrate-binding domain β weakly binds to the spike RBD combined with ACE2 of the spike RBD-ACE2 complex. Its main function is to stabilize the binding between RBD and ACE2, while CotH3 has a strong affinity for the SARS-CoV-2 RBD, but not for ACE2 or GRP78. The CotH3 appeared to have the same affinity to RBD in the SARS-CoV-2 lineages with some preference to the lineage B.1.617.2 (Delta variant). The complex design illustrates that the coat protein of the fungi is more likely linked to the spike protein of the SARS-CoV-2 virus, which would explain the increased mortality mucormycosis coinfections in COVID-19 patients.</p> </abstract>

Both simulation and sequencing data reveal coinfections with multiple SARS-CoV-2 variants in the COVID-19 pandemic

SARS-CoV-2 is a single-stranded RNA betacoronavirus with a high mutation rate. The rapidly emerging SARS-CoV-2 variants could increase transmissibility and diminish vaccine protection. However, whether coinfection with multiple SARS-CoV-2 variants exists remains controversial. This study collected 12,986 and 4,113 SARS-CoV-2 genomes from the GISAID database on May 11, 2020 (GISAID20May11), and Apr 1, 2021 (GISAID21Apr1), respectively. With single-nucleotide variant (SNV) and network clique analyses, we constructed single-nucleotide polymorphism (SNP) coexistence networks and discovered maximal SNP cliques of sizes 16 and 34 in the GISAID20May11 and GISAID21Apr1 datasets, respectively. Simulating the transmission routes and SNV accumulations, we discovered a linear relationship between the size of the maximal clique and the number of coinfected variants. We deduced that the COVID-19 cases in GISAID20May11 and GISAID21Apr1 were coinfections with 3.20 and 3.42 variants on average, respectively. Additionally, we performed Nanopore sequencing on 42 COVID-19 patients and discovered recurrent heterozygous SNPs in twenty of the patients, including loci 8,782 and 28,144, which were crucial for SARS-CoV-2 lineage divergence. In conclusion, our findings reported SARS-CoV-2 variants coinfection in COVID-19 patients and demonstrated the increasing number of coinfected variants.

The role of SARS-CoV-2 immunosuppression and the therapy used to manage COVID-19 disease in the emergence of opportunistic fungal infections: A review.

Since December 2019 SARS-CoV-2 infections have affected millions of people worldwide. Along with the increasing number of COVID-19 patients, the number of cases of opportunistic fungal infections among the COVID-19 patients is also increasing. There have been reports of the cases of aspergillosis and candidiasis in the COVID-19 patients. The COVID-19 patients have also been affected by rare fungal infections such as histoplasmosis, pneumocystosis, mucormycosis and cryptococcosis. These fungal infections are prolonging the stay of COVID-19 patients in hospital. In this study several published case reports, case series, prospective and retrospective studies were investigated to explore and report the updated information regarding candidiasis, crytptococcosis, aspergillosis, mucormycosis, histoplasmosis, and pneumocystosis infections in COVID-19 patients. In this review, the risk factors of these co-infections in COVID-19 patients have been reported. There have been reports that the comorbidities and the treatment with corticoids, monoclonal antibodies, use of mechanical ventilation, and use of antibiotics during COVID-19 management are associated with the emergence of fungal infections in the COVID-19 patients. Hence, this review analyses the role of these therapies and comorbidities in the emergence of these fungal infections among COVID-19 patients. This review will help to comprehend if these fungal infections are the result of the co-morbidities, and treatment protocol followed to manage COVID-19 patients or directly due to the SARS-CoV-2 infection. The analysis of all these factors will help to understand their role in fungal infections among COVID-19 patients which can be valuable to the scientific community.

Misuse of Antibiotic during COVID 19 Outbreaks

The COVID-19 outbreak, caused by the severe acute respiratory syndrome coronavirus 2, has been detected in December 2019 in Wuhan, China, and is accompanied by significant degrees of morbidity and mortality. Antibiotic resistance (AMR) threatens to wreak havoc on healthcare system and the impact of globalization, and COVID-19 is intended to keep it at bay for the time being. During the COVID-19 crisis, a wide range of antimicrobial medicines were promoted as viable treatments. While both industrialized and industrializing nations have seen a rise in antimicrobial medication usage, use and abuse have been significantly more prevalent in developing countries. Antibiotic resistance is still a concern since microorganisms that cause resistant infections develop in hospitals and medical institutions, placing all patients at risk, complicating the care of COVID-19. Improper prescriptions, a lack of care management policies and needless self-administration by the general population are examples of these. Antibiotics seem to be more motivated to abuse and misusing antibiotics than to keep them safe and take them only when prescribed. Almost all of the substantial antibiotic usage in COVID-19 patients is inevitable. Patients having lung viral infections are more likely to develop subsequent bacterial infections, which lead to higher disease severity and death. Immediately crucial components of any AMR mitigation approach are increased spending in education and increased public knowledge of AMR. More studies are needed to better understand the health risks and rate of co-infection in COVID-19 patients in order to promote a decrease in any unnecessary antimicrobial prescribing.
 Keywords: COVID-19; Antibiotic use and misuse; Antimicrobial Resistance.

Impact of Coinfection With SARS-CoV-2 and Influenza on Disease Severity: A Systematic Review and Meta-Analysis.

Background: Although coinfection with influenza in COVID-19 patients has drawn considerable attention, it is still not completely understood whether simultaneously infected with these two viruses influences disease severity. We therefore aimed to estimate the impact of coinfected with SARS-CoV-2 and influenza on the disease outcomes compared with the single infection of SARS-CoV-2.Materials and Methods: We searched the PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI) to identify relevant articles up to July 9, 2021. Studies that assessed the effect of SARS-CoV-2 and influenza coinfection on disease outcomes or those with sufficient data to calculate risk factors were included. Risk effects were pooled using fixed or random effects model.Results: We ultimately identified 12 studies with 9,498 patients to evaluate the risk effects of SARS-CoV-2 and influenza coinfection on disease severity. Results indicated that coinfection was not significantly associated with mortality (OR = 0.85, 95%CI: 0.51, 1.43; p = 0.55, I2 = 76.00%). However, mortality was found significantly decreased in the studies from China (OR = 0.51, 95%CI: 0.39, 0.68; I2 = 26.50%), while significantly increased outside China (OR = 1.56, 95%CI: 1.12, 2.19; I2 = 1.00%). Moreover, a lower risk for critical outcomes was detected among coinfection patients (OR = 0.64, 95%CI: 0.43, 0.97; p = 0.04, I2 = 0.00%). Additionally, coinfection patients presented different laboratory indexes compared with the single SARS-CoV-2 infection, including lymphocyte counts and APTT.Conclusion: Our study revealed that coinfection with SARS-CoV-2 and influenza had no effect on overall mortality. However, risk for critical outcomes was lower in coinfection patients and different associations were detected in the studies from different regions and specific laboratory indexes. Further studies on influenza strains and the order of infection were warranted. Systematic testing for influenza coinfection in COVID-19 patients and influenza vaccination should be recommended.

304. Impact of Antibiotic Prophylaxis Prior to Treatment with Steroids and Tocilizumab in COVID-19 Patients

BackgroundThe incidence of bacterial or fungal coinfections in COVID-19 patients is low. The incidence of nosocomial superinfections is higher, especially related to ICU admission. Treating COVID-19 with steroids plus tocilizumab (TCZ) has been associated with superinfections. Therefore, the use of antibiotic prophylaxis prior to infusion of TCZ could be considered to reduce the risk of life-threatening superinfections in critically ill patients.MethodsRetrospective, single center cohort study. COVID-19 patients older than 14 years, admitted to Hospital Central de la Defensa (Madrid, Spain) from Mar 5th to Nov 24th, 2020 with a diagnosis of COVID-19 were included. Local protocols suggested antimicrobial prophylaxis before the infusion of TCZ. Medical records, treatments received, and microbiological data of all patients who received TCZ were reviewed. Microbiological isolates were considered in the 14 days following the administration of TCZ. Two ID specialists independently reviewed the medical record and decided to qualify the isolate as superinfection or colonization.Results2,069 patient records were analyzed. 70 patients received TCZ; all of them were admitted to ID wards and under steroid treatment. 45 (64,5%) patients received antibiotic prophylaxis. The preferred antibiotics were ceftriaxone (N = 18) and ceftobiprole (N = 14). No significant differences were found in age, Charlson index or COVID-19 SEIMC-Score. 24 isolates were detected in 14 patients (18 bacterial, 6 fungal). 17 isolates were considered superinfections; the most frequent isolates were C. albicans (N=5), E. faecalis (N=3) and S. epidermidis (N=2). There were no statistically significant differences between the different prophylaxis strategies in terms of in-hospital mortality or ICU admission. However, patients who received ceftobiprole tended to have fewer isolates and fewer superinfections than those receiving ceftriaxone (ceftobiprole group: 2 isolates in 1 patient, 1 (7,1%) patient with superinfection; ceftriaxone 11 isolates in 5 patients, 4 (22,2%) patients with superinfection) (p= 0,35, Fisher exact test).Table 1. Characteristics of study population. Table 2. Outcomes according to antimicrobial prophylaxis prior to Tocilizumab. Table 3. Description of isolates. ConclusionAntibiotic prophylaxis prior to infusion of TCZ in patients with COVID-19 and receiving steroids could determine the profile of bacterial and fungal superinfections.Disclosures All Authors: No reported disclosures

Frequency and antimicrobial resistance pattern of bacterial isolates from patients with COVID-19 in two hospitals of Zanjan.

Background and Objectives:The outbreak of COVID-19 has been challenging the global health systems. As one of the major associated concerns, microbial co-infections and antimicrobial resistance play critical roles in the prognosis of the disease. This study aims to evaluate co-infections in COVID-19 patients regarding drug resistance.Materials and Methods:A total number of 5530 Real Time PCR-confirmed COVID-19 cases, who were admitted to two major educational Hospitals in Zanjan, Iran, from February 2019 to February 2020 were included. Respiratory, blood and urine specimens were collected and cultured on selective media. Subsequently, isolates identification, disc diffusion susceptibility tests, and data analysis were carried out.Results:Bacterial and fungal co-infections were confirmed in 423 patients (8.1%). Co-infections were more prevalent among females (53.2%) than males (46.8%). Coinfected patients had a significantly higher mortality rate compared to those without co-infections (54.8% vs. 12.2%, P<0.001). Acinetobacter baumannii was the most prevalent bacteria isolated from respiratory tract (15.4%) and blood (2.1%). Escherichia coli (12.5%) was the most frequent bacteria in urine. Fungal co-infection was confirmed in 174 (3.36%) patients. Gram-negative bacteria were highly sensitive to colistin (97.85%) and widely resistant to cefixime (91.79%) and trimethoprim-sulfamethoxazole (89.64%). Gram-positive bacteria were considerably sensitive to vancomycin (68%) and nitrofurantoin (66%). Tetracycline and ampicillin were the least effective antibiotics for Gram-positive bacteria with respective resistance rates of 90.91% and 83.33%.Conclusion:Given the high incidence of bacterial co-infections in COVID-19 patients, it is important to develop rapid and efficient diagnostic, therapeutic and disinfection guidelines to control these infections in the hospitals.

Post-COVID fungal infections of maxillofacial region: a systematic review.

With the advent of coronavirus disease (COVID-19) pandemic, a wide range of life-threatening maxillofacial fungal coinfections have also been observed in patients. We conducted this systematic review to collate and evaluate the data to enable clinicians to understand the disease pattern and types of mycosis and provide meticulous management of these infections in COVID-19 patients. The review was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A systematic electronic literature search was conducted on major databases using keywords in combination with Boolean Operators. Manuscripts discussing cases of maxillofacial fungal infections in COVID-19 patients were included. A total of 11 studies were systematically reviewed to assess the fungal coinfections in COVID-19 patients. Twenty-one cases of mucormycosis, 58 of candidiasis, and 1 each of aspergillosis and mixed infection were observed in the region of head and neck. Significant increase in invasive fungal infection is evident in patients suffering from COVID-19 which could be due to immunosuppression and other pre-existing comorbidities. Early diagnosis and intervention like systemic antifungals or surgical debridement is mandatory to reduce morbidity and mortality.

A systematic review on SARS-CoV-2-associated fungalcoinfections.

A severe pandemic of Coronavirus Disease (COVID‐19) has been sweeping the globe since 2019, and this time, it did not stop, with frequent mutations transforming into virulent strains, for instance, B.1.1.7, B.1.351, and B.1.427. In recent months, a fungal infection, mucormycosis has emerged with more fatal responses and significantly increased mortality rate. To measure the severity and potential alternative approaches against black fungus coinfection in COVID‐19 patients, PubMed, Google Scholar, World Health Organization (WHO) newsletters, and other online resources, based on the cases reported and retrospective observational analysis were searched from the years 2015–2021. The studies reporting mucormycosis with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) coinfection and/or demonstrating potential risk factors, such as a history of diabetes mellitus or suppressed immune system were included, and reports published in non‐English language were excluded. More than 20 case reports and observational studies on black fungus coinfection in COVID‐19 patients were eligible for inclusion. The results indicated that diabetes mellitus, hyperglycemic, and immunocompromised COVID‐19 patients with mucormycosis were at a higher risk. We found that it was prudent to assess the potential risk factors and severity of invasive mycosis via standardized diagnostic and clinical settings. Large‐scale studies need to be conducted to identify early biomarkers and optimization of diagnostic methods has to be established per population and geographical variation. This will not only help clinicians around the world to detect the coinfection in time but also will prepare them for future outbreaks of other potential pandemics.

Mucormycosis: An Epidemic Associated with Pandemic- A Systematic Review

Different infections have been presenting danger to mankind every once in a while and in 2019 a serious respiratory illness (COVID-19) reported in Wuhan, Hubei province of China, became a threat to general wellbeing not only in China but all the nations throughout the world. COVID-19 disease which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found to be associated with a wide range of opportunistic fungal and bacterial infections. Candidial and aspergillus infections leading to mucormycosis and orbital compartment syndrome have been reported to be the main co-infections in COVID-19 patients, which must be recognized and treated promptly to avoid any morbidity and mortality. Low oxygen environment, acidic medium, high glucose, decreased phagocytic activity and increased ferritin levels in addition to prolonged hospitalization with or without mechanical ventilators are considered as the main risk factors. Thus, the main aim of the article is to briefly survey and discuss about the types, causes, methods to prevent and treatment modalities of main co-morbidity of COVID 19 i.e. mucormycosis.

Candida spp. co-infection in COVID-19 patients with severe pneumonia: Prevalence study and associated risk factors

BackgroundInvasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet. ObjectivesWe aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis. Patients/methodsWe designed a study including patients with a confirmed diagnosis of COVID-19. ResultsThe prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1β and Lopinavir-Ritonavir. ConclusionsResults suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.

Evaluation of bacterial co-infections in COVID-19 patients admitted in ICU

Evaluation of bacterial co-infections in COVID-19 patients admitted in ICU

The ‘black fungus’ Co-Infection in COVID-19 Patients : A Review

Mucormycosis is one type of fungal disease, associated with a poor prognosis if not promptly diagnosed and managed because its highly aggressive tendency. Although it is a rare disease, a rapid increase in cases of mucormycosis associated with COVID-19 is being reported. Mostly, risk factors for this disease are uncontrolled diabetes mellitus, other immunosuppressive conditions and corticosteroid therapy. Immune dysfunction, lung pathology and corticosteroid therapy in COVID-19 patients making it more susceptible to develop fungal infection including mucormycosis. The combination of steroid therapy and underlying diabetes mellitus in COVID-19 also can augment immunosuppression and hyperglycemia. Control of hyperglycemia, early treatment with liposomal amphotericin B, and surgery are three important factors in mucormycosis therapy that essential for successful management. However, in this COVID-19 pandemic situation, that management strategies are compromised. First, hyperglicemia can be aggravated by glucocorticoid, therapy that used widely for COVID-19 especially in severe case. Second, patients with ARDS and multiorgan dysfunction can prevent timely diagnostic for imaging and other testing, so appropriate therapy that should be given will be delayed. Last, the essential service in hospital such surgery in this pandemic era reduced signifi cantly to prevent the spread of COVID-19. This review was created with the aim mucormycosis co-infection can be considered in patients with COVID-19, especially with known risk factor. Prompt and rapid diagnosis are important for eff ective therapy and decreasing case fatality rate. The use of steroid in mild cases, utilization of higher doses of steroid and drugs that targeting immune pathway should be avoided.

Synthesis and Study of Antifungal Properties of New Cationic Beta-Glucan Derivatives.

The interaction of positively charged polymers (polycations) with a biological membrane is considered to be the cause of the frequently observed toxicity of these macromolecules. If it is possible to obtain polymers with a predominantly negative effect on bacterial and fungal cells, such systems would have great potential in the treatment of infectious diseases, especially now when reports indicate the growing risk of fungal co-infections in COVID-19 patients. We describe in this article cationic derivatives of natural beta-glucan polymers obtained by reacting the polysaccharide isolated from Saccharomyces boulardii (SB) and Cetraria islandica (CI) with glycidyl trimethyl ammonium chloride (GTMAC). Two synthesis strategies were applied to optimize the product yield. Fungal diseases particularly affect low-income countries, hence the emphasis on the simplicity of the synthesis of such drugs so they can be produced without outside help. The three structures obtained showed selective anti-mycotic properties (against, i.e., Scopulariopsis brevicaulis, Aspergillus brasiliensis, and Fusarium solani), and their toxicity established using fibroblast 3T3-L1 cell line was negligible in a wide range of concentrations. For one of the polymers (SB derivative), using in vivo model of Aspergillus brasiliensis infection in Galleria mellonella insect model, we confirmed the promising results obtained in the preliminary study.

Co-infections observed in SARS-CoV-2 positive patients using a rapid diagnostic test

Rapid diagnostic tests are tools of paramount impact both for improving patient care and in antimicrobial management programs. Particularly in the case of respiratory infections, it is of great importance to quickly confirm/exclude the involvement of pathogens, be they bacteria or viruses, while obtaining information about the presence/absence of a genetic target of resistance to modulate antibiotic therapy. In this paper, we present our experiences with the use of the Biofire® FilmArray® Pneumonia Panel Plus (FAPP; bioMérieux; Marcy l’Etoile, France) to assess coinfection in COVID-19 patients. A total of 152 respiratory samples from consecutive patients were examined, and 93 (61%) were found to be FAPP positive, with the detection of bacteria and/or viruses. The patients were 93 males and 59 females with an average age of 65 years who were admitted to our hospital due to moderate/severe acute respiratory symptoms. Among the positive samples were 52 from sputum (SPU) and 41 from bronchoalveolar lavage (BAL). The most representative species was S. aureus (most isolates were mecA positive; 30/44, 62%), followed by gram-negative pathogens such as P. aeruginosa, K. pneumoniae, and A. baumannii. Evidence of a virus was rare. Cultures performed from BAL and SPU samples gave poor results. Most of the discrepant negative cultures were those in which FAPP detected pathogens with a microbial count ≤ 105 CFU/mL. H. influenzae was one of the most common pathogens lost by the conventional method. Despite the potential limitations of FAPP, which detects a defined number of pathogens, its advantages of rapid detection combined with predictive information regarding the antimicrobial resistance of pathogens through the detection of some relevant markers of resistance could be very useful for establishing empirical targeted therapy for the treatment of patients with respiratory failure. In the COVID era, we understand the importance of using antibiotics wisely to curb the phenomenon of antibiotic resistance.

Coinfections with Other Respiratory Pathogens among Patients with COVID-19.

ABSTRACTEmerging evidence indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals are at an increased risk for coinfections; therefore, physicians need to be cognizant about excluding other treatable respiratory pathogens. Here, we report coinfection with SARS-CoV-2 and other respiratory pathogens in patients admitted to the coronavirus disease (COVID) care facilities of an Indian tertiary care hospital. From June 2020 through January 2021, we tested 191 patients with SARS-CoV-2 for 33 other respiratory pathogens using an fast track diagnostics respiratory pathogen 33 (FTD-33) assay. Additionally, information regarding other relevant respiratory pathogens was collected by reviewing their laboratory data. Overall, 13 pathogens were identified among patients infected with SARS-CoV-2, and 46.6% (89/191) of patients had coinfection with one or more additional pathogens. Bacterial coinfections (41.4% [79/191]) were frequent, with Staphylococcus aureus being the most common, followed by Klebsiella pneumoniae. Coinfections with SARS-CoV-2 and Pneumocystis jirovecii or Legionella pneumophila were also identified. The viral coinfection rate was 7.3%, with human adenovirus and human rhinovirus being the most common. Five patients in our cohort had positive cultures for Acinetobacter baumannii and K. pneumoniae, and two patients had active Mycobacterium tuberculosis infection. In total, 47.1% (90/191) of patients with coinfections were identified. The higher proportion of patients with coinfections in our cohort supports the systemic use of antibiotics in patients with severe SARS-CoV-2 pneumonia with rapid de-escalation based on respiratory PCR/culture results. The timely and simultaneous identification of coinfections can contribute to improved health of COVID-19 patients and enhanced antibiotic stewardship during the pandemic.IMPORTANCE Coinfections in COVID-19 patients may worsen disease outcomes and need further investigation. We found that a higher proportion of patients with COVID-19 were coinfected with one or more additional pathogens. A better understanding of the prevalence of coinfection with other respiratory pathogens in COVID-19 patients and the profile of pathogens can contribute to effective patient management and antibiotic stewardship during the current pandemic.

Respiratory coinfections in COVID-19 patients evaluated by BioFire Pneumonia Panel

BackgroundRoutine administration of antibacterials in patients with Covid-19 has been a subject of debate, with no solid data about the true prevalence of respiratory coinfections in Covid-19 patients in different geographic areas. The aim of the current study was to identify respiratory coinfections in Covid-19 patients admitted to the hospital and to identify its genetic resistance pattern using the respiratory multiplex polymerase chain reaction (PCR).ResultsThe study included 40 patients, 32 males (80%) and 8 (20%) females with a mean age of 59.3 ± 12.6. Half of the patients had respiratory bacterial coinfections documented by pneumonia (PN) panel. The most common isolate was Klebsiella pneumoniae (10/20, 50%), followed by Acinetobacter calcoaceticus baumanni complex (7/20, 35%). Regarding genetic resistance, thirteen (13/20, 65%) isolates were proven extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae. Thirteen (13/20, 65%) isolates were proven carbapenemase-producing organisms testing positive for New Delhi metallo-β-lactamase (NDM), oxacillinase β-lactamases (OXA-48), and Verona Integron-Encoded Metallo-β-Lactamase (VIM) (7/20, 35%; 5/20, 25%; 1/20, 5%, respectively). The four isolated Staphylococcus aureus were methicillin-resistant (4/20, 20%).ConclusionIn our cohort, there was 50% rate of bacterial respiratory coinfection in patients with severe Covid-19 admitted to the ICU with high rates of carbapenemase-producing gram-negative bacteria that required escalation of antibacterials and represented a challenge to clinicians.

Coinfections in Patients Hospitalized with COVID-19: A Descriptive Study from the United Arab Emirates.

PurposeMicrobial coinfections in COVID-19 patients carry a risk of poor outcomes. This study aimed to characterize the clinical and microbiological profiles of coinfections in patients with COVID-19.MethodsA retrospective review of the clinical and laboratory records of COVID-19 patients with laboratory-confirmed infections with bacteria, fungi, and viruses was conducted. Only adult COVID-19 patients hospitalized at participating health-care facilities between February 1 and July 31, 2020 were included. Data were collected from the centralized electronic system of Dubai Health Authority hospitals and Sheikh Khalifa General Hospital Umm Al Quwain.ResultsOf 29,802 patients hospitalized with COVID-19, 392 (1.3%) had laboratory-confirmed coinfections. The mean age of patients with coinfections was 49.3±12.5 years, and a majority were male (n=330 of 392, 84.2%). Mean interval to commencement of empirical antibiotics was 1.2±3.6) days postadmission, with ceftriaxone, azithromycin, and piperacillin–tazobactam the most commonly used. Median interval between admission and first positive culture (mostly from blood, endotracheal aspirates, and urine specimens) was 15 (IQR 8–25) days. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli were predominant in first positive cultures, with increased occurrence of Stenotrophomonas maltophilia, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Candida auris, and Candida parapsilosis in subsequent cultures. The top three Gram-positive organisms were Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus. There was variability in levels of sensitivity to antibiotics and isolates harboring mecA, ESBL, AmpC, and carbapenemase-resistance genes were prevalent. A total of 130 (33.2%) patients died, predominantly those in the intensive-care unit undergoing mechanical ventilation or extracorporeal membrane oxygenation.ConclusionDespite the low occurrence of coinfections among patients with COVID-19 in our setting, clinical outcomes remained poor. Predominance of Gram-negative pathogens, emergence of Candida species, and prevalence of isolates harboring drug-resistance genes are of concern.

Coinfections among hospitalized patients with covid-19 in the first pandemic wave

BackgroundCOVID19 is the novel respiratory illness caused by SARS-CoV-2. The presence of other potentially pathogenic microorganisms could worsen the prognosis of these patients. Aim: The study aims to describe coinfections in COVID-19 patients and contrast it between standard ward and critical care patients at Hospital Central de la Defensa Gómez Ulla (HCDGU). MethodsA retrospective study was carried out of patients with COVID-19 confirmed with RTPCR admitted to the HCDGU from March 5, 2020 to May 7 of 2020. FindingsOf a total of 703 patients with COVID-19, 75(10.7%) had other microbiologically confirmed infections: 9% (58/648) in standard ward patients and 31.5%(17/54) in critical care patients. In total 86 samples of the 75 patients presented some microorganism; clinically relevant bacteraemias, 50%, respiratory cultures, 32.6% and pneumococcal positive antigens, 17.4%. ConclusionsWe found a low frequency of microorganism coinfection in COVID-19 patients, however in critical care these coinfections increased considerably.

Mucormycosis, The Black Fungus alarming Coinfections in Covid-19 Patients

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global pandemic causing coronavirus disease 2019 (COVID-19). It was firstly reported in Hubei province in the People’s Republic of China and spread worldwide quickly. The COVID-19 affects every person differently, from mild to life-threatening symptoms (Nawaz, 2020), along with other bacterial or fungal co-infections (CDC., 2021). The COVID-19 affected patients are prone to develop severe opportunistic infections (Salehi et al., 2020). The immune system of SARS-COV-2 infected patients becomes vulnerable to these opportunistic infections if some comorbidities (diabetes, pulmonary disease) or immunocompromised conditions (steroid therapy, hospital stay, and ventilation) are present. The development of infections such as Pneumocystis jiroveci pneumonia, bloodstream candida, pulmonary aspergillosis, and oropharyngeal candidiasis have been reported in SARS-CoV-2 infected patients (Moorthy et al., 2021). A few case reports of rhino-orbital mucormycosis in COVID-19 have been reported (Mehta et al., 2020). One such study was reported by (Sen et al., 2021), in which they presented a series of six cases of COVID-19 disease with rhino-orbital mucormycosis. Only one patient in this series had concurrent COVID-19 and mucormycosis at hospital admission, while five patients developed mucormycosis during treatment for COVID-19. Recent studies in Pakistan have reported an increased number of cases of mucormycosis, also known as “black fungus” in COVID-19 patients (The News., 2021).