Evaluation of Bacterial Coinfection and Antibiotic Resistance in Patients with COVID-19 Under Mechanical Ventilation

Patients with confirmed SARS-CoV-2 are principally at risk of emerging superinfections, particularly those caused by Gram-negative bacteria. Therefore, in this retrospective cohort study, we investigated the presence of bacteria in endotracheal aspirate samples in severe COVID-19 patients under mechanical ventilation between 20 February 2020 and 21 September 2020 in Mazandaran Heart Center Hospital, Iran. Outcomes were compared between ICU patients with confirmed SARS-CoV-2 (corona group) and those who suffer from other disease (non-corona group). Out of 38 subjects who met the diagnostic criteria for ventilator-associated pneumonia (VAP) in ICU, 22 and 16 patients in corona and non-corona groups, respectively, were enrolled in the study. Hospital length of stay in 27% of case in corona group was > 10 days. Also, SOFA score was > 10 in 64% and 25% of corona and non-corona groups, respectively (P < 0.05). Moreover, the number of death was significantly higher among corona patients (45%) than non-corona group (6%) in ICU (P < 0.05). Acinetobacter spp. were the most common bacteria in nine corona patients (41%) that were 100% resistant to amikacin, gentamycin, cefixime, and imipenem antibiotics. The prevalence of antibiotic resistance among pathogens isolated from patients with COVID-19 under mechanical ventilation in ICU highlighted the importance of preventing coinfections caused by this pathogen, suggesting an essential standardized approach to antibiotic stewardship in patients with COVID-19 for successful treatment.