Moradi Narges, Kazemi Niloufar, Ghaemi Mehdi, Mirzaei Bahman
Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran.
Department of Anestheiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Iran J Microbiol. 2021 Dec;13(6):769-778. doi: 10.18502/ijm.v13i6.8078.
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.
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.
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). was the most prevalent bacteria isolated from respiratory tract (15.4%) and blood (2.1%). (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%.
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.
新型冠状病毒肺炎（COVID-19）疫情给全球卫生系统带来了挑战。作为主要相关问题之一，微生物合并感染和抗菌药物耐药性在该疾病的预后中起着关键作用。本研究旨在评估COVID-19患者合并感染的耐药情况。
纳入2019年2月至2020年2月在伊朗赞詹两家主要教学医院收治的5530例经实时聚合酶链反应（Real Time PCR）确诊的COVID-19病例。采集呼吸道、血液和尿液标本，并在选择性培养基上进行培养。随后，进行分离株鉴定、纸片扩散药敏试验及数据分析。
423例患者（8.1%）确诊存在细菌和真菌合并感染。合并感染在女性中（53.2%）比男性中（46.8%）更为普遍。与未合并感染的患者相比，合并感染患者的死亡率显著更高（54.8%对12.2%，P<0.001）。 是从呼吸道分离出的最常见细菌（15.4%），也是血液中最常见的细菌（2.1%）。 （12.5%）是尿液中最常见的细菌。174例（3.36%）患者确诊存在真菌合并感染。革兰氏阴性菌对黏菌素高度敏感（97.85%），对头孢克肟（91.79%）和复方新诺明（89.64%）广泛耐药。革兰氏阳性菌对万古霉素（68%）和呋喃妥因（66%）相当敏感。四环素和氨苄西林对革兰氏阳性菌效果最差，耐药率分别为90.91%和83.33%。
鉴于COVID-19患者中细菌合并感染的高发生率，制定快速有效的诊断、治疗和消毒指南以控制医院内这些感染非常重要。
