Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units

Zahra Rafat; Alireza Ramandi; Pegah Afarinesh Khaki; Saham Ansari; Sara Ghaderkhani; Hassan Haidar; Faezeh Tajari; Davoud Roostaei; Roshanak Daei Ghazvini; Seyed Jamal Hashemi; Alireza Abdollahi; Hasti Kamali Sarvestani

doi:10.1016/j.genrep.2022.101588

Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units

Gene Rep. 2022 Jun:27:101588. doi: 10.1016/j.genrep.2022.101588. Epub 2022 Mar 8.

Authors

Affiliations

¹ Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
² Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Molecular Genetics, Faculty of Advanced Science and Technology, Islamic Azad University, Tehran, Iran.
⁴ Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
⁶ School of Medicine, Marmara University, Istanbul, Turkey.
⁷ Students' Scientific Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁸ Department of Pharmacology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
⁹ Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
¹⁰ Department of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran.

Abstract

Backgrounds: The pandemic of COVID-19 has created a global public health crisis. ICU patients with COVID-19 are prone to infections of bacterial and/or fungal origins due to several risk factors. Consequently, the current study was conducted to evaluate the frequency, demographic characteristics, underlying conditions, and etiologic agents of fungal and bacterial co-infections of the respiratory tract among ICU patients with COVID-19 in Iran.

Materials and methods: From May to October 2020, sputa and endotracheal aspirates were collected from ICU patients hospitalized with COVID-19 who also were suspected of bacterial and/or fungal co-infections according to inclusion criteria. The etiologic agents of bacterial co-infections were identified using the Vitek 2 identification method. For fungal identification, all samples were analyzed by direct microscopy using KOH 10% and culture. Furthermore, all isolates were subjected to sequencing method.

Results: A total of 73 lung specimens were obtained from patients who met the inclusion criteria. Of these, in 15 cases (20.54%) fungal and/or bacterial co-infections were confirmed. Males were more infected (73.33%) and all of them were between 49 and 79 years. Candida albicans (n = 8, 61.53%) and Klebsiella pneumoniae (n = 5, 38.46%) were the most frequent etiologic agents related to fungal and bacterial co-infections, respectively. Pneumonia (n = 15, 100%) and diabetes mellitus (n = 8, 53.33%) were documented as the most prevalent underlying conditions. In the current study, 3 out of 15 patients (20%) died.

Conclusion: The frequency of bacterial co-infections of the respiratory tract in ICU patients hospitalized with COVID-19 was relatively high. According to the results, one of the causes of death of these patients could be a secondary infection.

Keywords: BHI, Brain Heart Infusion; Bacterial infections; COVID-19; COVID-19, coronavirus disease 2019; Coinfection; Fungal infection; Iran; Respiratory tract; SARS-CoV-2, Severe Acute Respiratory Coronavirus 2; SDA, Sabouraud Dextrose Agar.