Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Av. Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
Hospital Eduardo de Menezes, Fundação Hospitalar Do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil.
Braz J Microbiol. 2022 Dec;53(4):1925-1935. doi: 10.1007/s42770-022-00818-x. Epub 2022 Sep 10.
Secondary infections are one of the complications in COVID-19 patients. We aimed to analyze the antimicrobial prescriptions and their influence on drug resistance in fungi and bacteria isolated from severely ill COVID-19 patients. Seventy-nine severely ill COVID-19 hospitalized patients with secondary bacterial or fungal infections were included. We analyzed the prescribed antimicrobial regimen for these patients and the resistance profiles of bacterial and fungal isolates. In addition, the association between drug resistance and patients' outcome was analyzed using correlation tests. The most prescribed antibacterial were ceftriaxone (90.7% of patients), vancomycin (86.0%), polymyxin B (74.4%), azithromycin (69.8%), and meropenem (67.4%). Micafungin and fluconazole were used by 22.2 and 11.1% of patients, respectively. Multidrug-resistant (MDR) infections were a common complication in severely ill COVID-19 patients in our cohort since resistant bacteria strains were isolated from 76.7% of the patients. Oxacillin resistance was observed in most Gram-positive bacteria, whereas carbapenem and cephalosporin resistance was detected in most Gram-negative strains. Azole resistance was identified among C. glabrata and C. tropicalis isolates. Patients who used more antimicrobials stayed hospitalized longer than the others. The patient's age and the number of antibacterial agents used were associated with the resistance phenotype. The susceptibility profile of isolates obtained from severely ill COVID-19 patients highlighted the importance of taking microbial resistance into account when managing these patients. The continuous surveillance of resistant/MDR infection and the rational use of antimicrobials are of utmost importance, especially for long-term hospitalized patients with COVID-19.
继发感染是 COVID-19 患者的并发症之一。我们旨在分析从重症 COVID-19 患者中分离出的真菌和细菌的抗菌药物处方及其对耐药性的影响。纳入了 79 例患有继发性细菌或真菌感染的重症 COVID-19 住院患者。我们分析了这些患者的抗菌药物治疗方案以及细菌和真菌分离物的耐药谱。此外，还使用相关测试分析了药物耐药性与患者预后之间的关系。最常开的抗菌药物是头孢曲松（90.7%的患者）、万古霉素（86.0%）、多黏菌素 B（74.4%）、阿奇霉素（69.8%）和美罗培南（67.4%）。分别有 22.2%和 11.1%的患者使用了米卡芬净和氟康唑。在我们的队列中，由于从 76.7%的患者中分离出了耐药菌，因此多重耐药（MDR）感染是重症 COVID-19 患者的常见并发症。大多数革兰阳性菌对苯唑西林耐药，而大多数革兰阴性菌对碳青霉烯类和头孢菌素耐药。在 C. glabrata 和 C. tropicalis 分离物中发现了唑类耐药。使用更多抗菌药物的患者住院时间比其他患者长。患者的年龄和使用的抗菌药物数量与耐药表型相关。从重症 COVID-19 患者中分离出的分离物的药敏谱强调了在管理这些患者时考虑微生物耐药性的重要性。对耐药/多药耐药感染的持续监测和抗菌药物的合理使用非常重要，尤其是对长期住院的 COVID-19 患者。
