Bacterial co-infection in patients with SARS-CoV-2 in the Kingdom of Bahrain

Nermin Kamal Saeed; Safaa Al-Khawaja; Jameela Alsalman; Safiya Almusawi; Noor Ahmed Albalooshi; Mohammed Al-Biltagi

doi:10.5501/wjv.v10.i4.168

Bacterial co-infection in patients with SARS-CoV-2 in the Kingdom of Bahrain

World J Virol. 2021 Jul 25;10(4):168-181. doi: 10.5501/wjv.v10.i4.168.

Authors

Nermin Kamal Saeed¹, Safaa Al-Khawaja², Jameela Alsalman², Safiya Almusawi¹, Noor Ahmed Albalooshi¹, Mohammed Al-Biltagi³

Affiliations

¹ Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 00000, Bahrain.
² Infection Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 00000, Bahrain.
³ Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 00000, Bahrain.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic presents a significant challenge to the medical profession, increasing in the presence of microbial co-infection. Bacterial and Fungal co-infections increase the risk of morbidity and mortality in patients with COVID-19.

Aim: To study the bacterial profile in patients with COVID-19 who needed admission to receive treatment in the main centres concerned with managing COVID-19 disease in the Kingdom of Bahrain.

Methods: The study was a retrospective observational analysis of the bacterial profile and the bacterial resistance in patients with confirmed COVID-19 disease who needed admission to receive treatment in the main centres assigned to manage patients with COVID-19 disease in the Kingdom of Bahrain from February to October 2020. We used the electronic patients' records and the microbiology laboratory data to identify patients' demographics, clinical data, microbial profile, hospital or community-acquired, and the outcomes.

Results: The study included 1380 patients admitted with confirmed COVID-19 disease during the study period. 51% were admitted from February to June, and 49% were admitted from July to October 2020, with a recurrence rate was 0.36%. There was a significant increase in bacterial and fungal co-infection in the second period compared to the first period. The most common isolated organisms were the gram-negative bacteria (mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, multi-drug resistant Acinetobacter baumannii, and Escherichia coli), the gram-positive bacteria (mainly coagulase negative Staphylococci, Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus) and fungaemia (Candida galabrata, Candida tropicalis, Candida albicans, Aspergillus fumigatus, Candida parapsilosis, Aspergillus niger). The hospital-acquired infection formed 73.8%, 61.6%, 100% gram-negative, gram-positive and fungaemia. Most of the hospital-acquired infection occurred in the second period with a higher death rate than community-acquired infections.

Conclusion: Bacterial and fungal co-infections in patients admitted with confirmed COVID-19 disease pose higher morbidity and mortality risks than those without co-infections. We should perform every effort to minimize these risks.

Keywords: Bacterial co-infection; COVID-19; Fungi; Hospital-acquired infection; Kingdom of Bahrain.