Rare COVID-19 co-infections are often treatment-resistant

Bacterial coinfection is rare in COVID-19, but frequent empirical use of antibiotics in COVID-19 patients is associated with the emergence of antimicrobial resistance (AMR) in coinfections and secondary infections. meta-analysis Bacterial infections and AMR occurring in COVID-19 to date.

“Antimicrobial resistance is a major problem and one of the leading causes of mortality worldwide, so the potential for COVID-19 to hasten this problem is of great public health concern,” said Dr. Bradley Langford, PharmD, lead author of the study, Public Health Ontario, Toronto, ON, said contagion.

“we previously identified About 75% of COVID-19 patients receive antibiotics, yet the co-infection rate is relatively low at less than 10%,” he said.

In the current analysis of 148 studies conducted on 362,976 patients in more than 40 countries, the prevalence of bacterial coinfection (identified within 48 hours of symptom onset) was 5.3% (95% CI 3.8–7.4), 18.4% (14.0–23.7) of patients treated for COVID-19 presented with secondary bacterial infections as outpatients or in hospital (>48 h). Moreover, 60.8% (38.6-79.3) of his bacterial infections occurring in COVID-19 patients showed his AMR. Resistance was found in 37.5% (26.9-49.5) of the isolates.

“Our systematic review actually confirmed that the prevalence of AMR in COVID-19 patients with bacterial infections is quite high, especially for Gram-negative bacteria,” said Langford. .

112 of the studies were conducted in high-income countries, 35 in lower-middle-income countries, and 1 in multiple regions. There was a higher probability of antibiotic-resistant strains in the Eastern Mediterranean, Southeast Asia, and Western Pacific regions compared with the Americas region. The odds of antimicrobial resistance were higher in low- and middle-income countries than in high-income countries, both at the patient-by-patient and organism-by-organism level.

“It is important to note that there was very high heterogeneity in the reported prevalence of AMR across studies and regions,” commented Langford. “This partly reflects the multifactorial nature of AMR. Several factors contribute to this variability, including underlying antibiotic use and pre-existing prevalence of AMR in his population.” They may be involved.”

The high prevalence of bacterial infections secondary to, rather than co-occurring with, COVID-19 was due in part to the increased risk of posthospital exposure.Intensive care patients, in particular, were more likely to require invasive interventions, with a corresponding increased risk of nosocomial infections.

The highest prevalence of resistance was reported for multidrug resistance stenotrophomonas spp (100%, 95% CI 82.6-100.0%);Acinetobacter spp, 96.5% (86.9-99.1) multidrug resistance and 95.9% (84.1-99.0) carbapenem resistance; and Klebsierra spp, 88.3% (6.7-99.9) resistant to colistin, 69.2% (49.6-83.6) resistant to carbapenems.

There has been considerable prevalence of AMR for several bacterial pathogens designated as . Priority According to WHO, including carbapenem resistance Acinetobacter baumannii (96% of isolates were carbapenem-resistant) and carbapenem-resistant enterobacteria (69% of isolates were Klebsierra species resistant to carbapenems).

To identify the impact of specific population-level variables on bacterial infection and AMR, the researchers applied univariate meta-regression of patient characteristics, medical settings, geographic region, and last month of the study to compare temporal evaluated trends. In addition to antibiotic use and ICU admission, patients with cardiovascular disease, diabetes, and IL-6 inhibitor use also had an increased risk of infection with resistant pathogens.

“Our findings highlight the importance of surveillance in tracking antimicrobial resistance over time to better understand trends and projections,” said Langford. “Second, this study reinforces the need for strong antimicrobial management and infection prevention efforts, especially in her COVID-19 patients.”