Journal Article Epublish
PubMed: 40422577 DOI: 10.3390/diseases13050145
Bacterial Superinfections After SARS-CoV-2 Pneumonia: Antimicrobial Resistance Patterns, Impact on Inflammatory Profiles, Severity Scores, and Clinical Outcomes.
Diseases 13(5)
Authors: Petrinela Daliu, Iulia Bogdan, Ovidiu Rosca, Alexandra Laura Aelenei, Ioan Sîrbu, Mihai Calin Bica, Monica Licker, Elena Hogea, Delia Muntean
Affiliations
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
- Department of Oral Implantology, Faculty of Dental Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
- Multidisciplinary Research Center of Antimicrobial Resistance, Department of Microbiology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
- Microbiology Laboratory, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania.
Abstract
Background and Objectives: Secondary bacterial pneumonia can substantially worsen the clinical trajectory of patients hospitalized for Coronavirus Disease 2019 (COVID-19). This study aimed to characterize bacterial superinfections in COVID-19, including pathogen profiles, resistance patterns, inflammatory responses, severity scores, and ICU admission risk. Methods: In a retrospective cohort design, we reviewed 141 patients admitted to a single tertiary-care hospital between February 2021 and December 2024. A total of 58 patients had laboratory-confirmed bacterial superinfection by sputum, bronchoalveolar lavage, or blood cultures (superinfection group), whereas 83 had COVID-19 without any documented bacterial pathogens (COVID-only group). We collected detailed microbiological data from sputum, bronchoalveolar lavage (BAL), and blood cultures. Antibiotic sensitivity testing was performed using standard breakpoints for multidrug resistance (MDR). Inflammatory markers (C-reactive protein, procalcitonin, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index) and the severity indices Acute Physiology and Chronic Health Evaluation (APACHE) II, Confusion, Urea, Respiratory rate, Blood pressure (CURB), and National Early Warning Score (NEWS) were measured at admission. Primary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and mortality. Results: Patients in the superinfection group showed significantly elevated inflammatory markers and severity scores compared to the COVID-only group (mean APACHE II of 17.2 vs. 13.8; p < 0.001). Pathogens most frequently isolated from sputum and BAL included Klebsiella pneumoniae (27.6%) and Pseudomonas aeruginosa (20.7%). Multidrug-resistant strains were documented in 32.8% of isolates. The superinfection group had higher ICU admissions (37.9% vs. 19.3%; p = 0.01) and more frequent mechanical ventilation (25.9% vs. 9.6%; p = 0.01). Mortality trended higher among superinfected patients (15.5% vs. 7.2%; p = 0.09). A total of 34% of the cohort had prior antibiotic use, which independently predicted MDR (aOR 2.6, p = 0.01). The presence of MDR pathogens such as Klebsiella pneumoniae (OR 2.8), Pseudomonas aeruginosa (OR 2.5), and Staphylococcus aureus (OR 2.1) significantly increases the risk of ICU admission. Conclusions: Bacterial superinfection exacerbates inflammation and worsens outcomes in COVID-19 patients, such as a higher risk of ICU admission.
MeSH
Sars-Cov-2, Bacterial Infections, Blood, Bronchoalveolar Lavage, Superinfection, Sputum, Covid-19, Pneumonia, Intensive Care Units, Blood Culture, Ventilation, Severe Acute Respiratory Syndrome-Related Coronavirus, Apache