COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria

Abstract

Bacterial co-infections may aggravate COVID-19 disease, and therefore being cognizant of other pathogens is imperative. We studied the types, frequency, antibiogram, case fatality rates (CFR), and clinical profiles of co-infecting-pathogens in 301 COVID-19 patients. Co-infection was 36% (<i>n</i> = 109), while CFR was 31.2% compared to 9.9% in non-co-infected patients (z-value = 3.1). Four bacterial species dominated, namely, multidrug-resistant <i>Klebsiella pneumoniae</i> (37%, <i>n</i> = 48), extremely drug-resistant <i>Acinetobacter baumannii</i> (26%, <i>n</i> = 34)<i>,</i> multidrug-resistant <i>Eschericia. coli</i> (18.6%, <i>n</i> = 24), and extremely drug-resistant <i>Pseudomonas aeruginosa</i> (8.5%, <i>n</i> = 11), in addition to other bacterial species (9.3%, <i>n</i> = 12). Increased co-infection of <i>K. pneumoniae</i> and <i>A. baumannii</i> was associated with increased death rates of 29% (<i>n</i> = 14) and 32% (<i>n</i> = 11), respectively. <i>Klebsiella pneumoniae</i> was equally frequent in respiratory and urinary tract infections (UTI), while <i>E. coli</i> mostly caused UTI (67%), and <i>A. baumannii</i> and <i>P. aeruginosa</i> dominated respiratory infections (38% and 45%, respectively). Co-infections correlated with advance in age: seniors ≥ 50 years (71%), young adults 21-49 years (25.6%), and children 0-20 years (3%). These findings have significant clinical implications in the successful COVID-19 therapies, particularly in geriatric management. Future studies would reveal insights into the potential selective mechanism(s) of Gram-negative bacterial co-infection in COVID-19 patients.