Etiological structure and profile of antimicrobial resistance of pathogens in bacteremia in COVID-19 patients

Goal. To investigate the spectrum of microorganisms, the level of antimicrobial resistance and to assess their effect on the outcomes of bacteremia among COVID­19 patients.

Materials and methods. A retrospective analysis of potentially resistant bacteria detected in blood and the mortality rate among COVID­19 patients and patients with other diagnoses in the period from 01.01. – 12/31/2020.

Results. In total, the analyzed pathogens were isolated from 168 patients, including 101 COVID­19 patients (group 1) and 67 patients with other diagnoses (group 2). Bloodstream infection were more often detected among COVID­19 patients (12.6 and 2.6 cases per 1000 patients, p<0.05). In group 1, the proportion of gram­-negative pathogens was higher than in group 2 (63.8% and 52.1%, p=0.012). The most commonly pathogen in group 1 is K. pneumoniae (31.5%, 41 cultures), in group 2 – S. aureus (35.2%, 25 cultures). Of particular importance is the identification of A. baumannii (32 and 4 cultures, p<0.001) and E. faecium (24 and 4 cultures, p=0.003) in group 1; S. aureus (25 and 11 cultures, p<0.001) and E. coli (9 and 6 cultures, p=0.038) – in group 2. Three leading types of microorganisms in group 1 have a high level of resistance: 96.9% of A. baumannii and 81.6% of K. pneumoniae were resistant to carbapenems, 36.8% of E. faecium was VRE. In group 1, several (22.8% and 6.0%, p=0.004) and resistant (70.3% and 41.8%, p<0.001) microorganisms were detected more frequently. The mortality rate of patients was higher in group 1 (68.3% and 50.7%, p=0.022). The occurrence of a bloodstream infection caused by a potentially resistant microorganism in COVID­19 patients is an unfavorable factor in the onset of death (p=0.022).

Conclusion. COVID­19 patients with bacteremia have a high level of polymicrobial associations with a predominance of gram­-negative bacteria both in their composition and as a monoinfection. The isolated microorganisms have a high level of antimicrobial resistance, which must be taken into account when choosing antibiotics.

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