Aim: The study aimed to discuss about Microbial profile and antimicrobial susceptibility pattern of pathogens isolated from long COVID-19 patients and their correlation to clinical outcome.
Background: Despite being reverse transcriptase-polymerase
chain reaction (RTPCR) negative for COVID infection, patients with persistent
symptoms for at least four weeks are classified as long-term COVID-19 patients
(pulmonary involvement is noted in a substantial number of cases). Patients who
have a history of long-term use of corticosteroids, broad-spectrum antibiotics,
and co-occurring illnesses are at a higher risk of contracting
multidrug-resistant microbial strains. A worse prognosis could result from it,
thus prompt microbiological assessment and treatment can improve the situation.
Methods: A retrospective observational study was carried out
among long COVID patients admitted to the Kalinga Institute of Medical
Sciences, Bhubaneswar, Odisha, India, a tertiary care hospital. Eighty-four
patients admitted to the ICU or non-ICU ward in the hospital from April to
October 2021 were included in the study. Antibiotics, as prescribed by our
hospital antibiotic policy, were administered wherever required and were
subsequently changed according to culture and sensitivity reports of the
samples (sputum, endotracheal aspirates, or blood). An analysis of the
antibiotic sensitivity patterns of the pathogens isolated was performed. The
outcome after optimum medical management was assessed for survivors, discharge,
or death.
Results: Out of the total of 84 patients, 41 samples
(sputum, endotracheal aspirates or blood) were collected and sent for culture,
of which 32 (78.1%) were found to be culture positive for pathogens. Among the
pathogens isolated, there were 22 (69%) drug-resistant and 10 (31%) sensitive
organisms. Among the 22 resistant pathogen isolates, 18 were Gram-negative
species, the most common species being Klebsiella pneumoniae, Pseudomonas
aeruginosa, and Acinetobacter baumanii; two were Gram-positive species, one
each from Staphylococcus aureus and Enterococcus faecalis, and three were
Candida tropicalis. Of five deaths reported among 22 cases with resistant
isolates, extensively drug-resistant (XDR), multi-drug resistance (MDR), and
pan drug resistance (PDR) strains were detected in three, one, and one cases,
respectively, and were harboured by K. pneumoniae, P. aeruginosa, and A.
baumanii. Of the total eight deaths, there were two deaths among the 43
patients who received an empiric antibiotic in the wards, and six deaths were
reported in the ICU. Despite raised biomarkers of inflammation, comorbid
illnesses, renal impairment, and immunocompromised states, there was 91%
survival and discharge, which was statistically significant (p- value = 0.00).
Conclusion: To conclude, K. pneumoniae, P. aeruginosa, A.
baumanii, C. tropicalis, S. aureus, and E. faecalis were the most commonly
isolated organisms among long COVID pneumonia cases, of which some were MDR,
PDR and XDR strains. Early microbiological evaluation with targeted, proper
antimicrobial usage along with optimized medical management and, wherever
needed, critical care support in the ICU may lead to a better prognostic
outcome in those groups of patients. The survival advantage could be due to the
better threshold of ICU care, judicious antimicrobial administration, and
keeping antimicrobial stewardship as a priority. Death was noticed among ICU
patients, those suffering from pneumonia, and those harbouring multi-drug-resistant
Gram-negative organisms.
Author(s) Details:
C. Mohan Rao,
Pulmonary Medicine Department, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Ashwini P. Pattnaik,
Nephrology Department, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Shubhransu Patro,
General Medicine Department, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Please see the link here: https://stm.bookpi.org/ANUMS-V8/article/view/13593
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