The Effects of SARS-CoV-2 Pandemic on the Distribution of Secondary Bacterial Pneumonia Agents and Antibiotic Resistance Profile in Intensive Care Units

Abstract

Since the World Health Organization declared COVID-19 (Coronavirus Disease 2019) a pandemic on March 11, 2020, SARS-CoV-2 has caused high rates of morbidity and mortality worldwide. The addition of secondary bacterial infections such as pneumonia to the clinical course led to more mortality of the disease. This situation has led to an increase in the use of antibiotics for both prophylactic and therapeutic purposes and has caused concerns about the increase in antibiotic resistance rates and multi-drug resistant strains. 679 COVID-19 patients (Group 1) with a diagnosis confirmed by polymerase chain reaction (PCR) and 366 patients who were followed up in the anesthesia intensive care unit (ICU) during the pandemic but had negative SARS-CoV-2 PCR test results (Group 2) were included in this study; all of them were treated in the ICU of our hospital between April 2020 - May 2022. In order to observe the possible effects of SARS-CoV-2 infection on the distribution of the causative agent and changes in antibiotic resistance patterns, the data of 363 patients (Group 3) who were treated in the anesthesia ICU between April 2017 and May 2019 (pre-pandemic period) were analyzed. Bacterial agents isolated from tracheal aspirate samples and antibiotic resistance rates of 1408 patients in the groups were determined. Pathogenic microorganism growth was detected in the tracheal aspirate samples of 430 (63.3%) of the patients followed in the COVID-19 ICUs. In the patients followed in COVID-19 ICUs, as secondary bacterial pneumonia agents, in order of frequency; Acinetobacter baumannii (39.6%), Klebsiella pneumoniae (35.5%) and Pseudomonas aeruginosa (3.5%) were isolated. A. baumannii and K. pneumoniae isolation rates were significantly higher in COVID-19 patients (Group 1) compared to non-COVID-19 ICU patients (Group 2) and were similarly higher in all patients in the pandemic period (Group 1 + Group 2) compared to the pre-epidemic period (p<0.001). Other remarkable findings were the presence of high antibiotic resistance rates in A. baumannii and K. pneumoniae strains isolated during the pandemic period, compared to the pre-pandemic period, and the observation of multi-drug resistance in the vast majority of isolates. In order to prevent the increased risk of mortality associated with concomitant secondary bacterial infections in patients followed in ICUs due to COVID-19; It is important to evaluate patients quickly in terms of bacterial infections, to take timely and appropriate antibiotic treatment and to take necessary isolation measures.