key: cord-0255698-t4aj7f7r authors: Haldar, A. K.; Mukherjee, D. N.; Seal, S.; Dasgupta, H.; Chakraborty, M. title: A comparative study of Bacterial culture isolates, site of infections and drug resistance pattern between COVID and non COVID patients admitted in a tertiary care hospital : A Pilot study date: 2021-09-15 journal: nan DOI: 10.1101/2021.09.12.21263386 sha: 28ea2605f89817bf6d434051868bdd3e0dbec9e3 doc_id: 255698 cord_uid: t4aj7f7r Introduction: SARS-CoV2 which is a corona virus also predisposes patient to secondary bacterial infection by various mechanisms like- damaging the respiratory epithelium, profoundly affecting the innate and adaptive immunity, antagonising Interferon responses that enhance bacterial adherence, colonisation and invasion to respiratory tissue. In addition, prolonged hospital stay, invasive therapeutic devices, widespread use of empiric antibiotics and most importantly use of immune-suppressants like Steroid or Tocilizumab further increases the chances of bacterial infection. As opposed to this concept- physical distancing, frequent hand washing and use of gloves and protective gear by the healthcare workers also diminishes the chance of secondary bacterial infection. The present study is done to delineate the bacteriological profile, infection site predisposition or to gain knowledge on antibiotic sensitivity pattern. Method : Retrospective data will be analyzed from June 2020, when the first COVID wave came to June 2021, corresponding to second COVID wave. The present study is a pilot study before collecting and analyzing the whole data Only those samples which were positive for bacterial isolates were randomly selected and the COVID status and drug resistance patterns were checked. Results and discussion: The most common organism found was Klebsiella. Acinetobacter was also found in few patients. But most striking finding was that COVID positive patients showed higher incidence of antibiotic resistance with Acinetobacter. Though E Coli was also found commonly in COVID positive patients, they were not drug resistant. Conclusion: MDR infections are common in COVID patients. Acinetobacter and Klebsiella are prone to develope MDR infections. While E.Coli is also common in COVID patients, chance of drug resistance is less among them. Probably because of these reasons a controversy still exists regarding increased propensity to develop bacterial infections in COVID patients. The present study is done to fulfil the gap in the knowledge and to delineate the bacteriological profile, infection site predisposition or to gain knowledge on antibiotic sensitivity pattern. Such data can also help in the antibiotic stewardship program [6, 7, 8] . The study will be conducted in the department of Microbiology in a tertiary care hospital which also includes COVID care. Ethicsl committee clearance has been taken before commencing the data collection. Retrospective data will be analyzed from June 2020, when the first COVID wave came to June 2021, corresponding to second COVID wave. The data will be analyzed statistically and any correlation or significance will be calculated with suitable statistical software. The present study is a pilot study before collecting and analyzing the whole data. The aim is to have an idea about the data trend, which may subsequently modify the data collection or interpretation methods. In the present study 30 random samples were taken from the whole period. Only those samples which were positive for bacterial isolates were selected and the COVID status and drug resistance patterns were checked. In the present study the isolates were not divided as hospital acquired or community acquired. The distributions of bacterial isolates among different groups were as above. Klebsiella was the most common organism recovered from the sample, while followed by E.Coli and Acinetobacter. Most of the klebsiella infections occurred among the COVID negative patients. 66.66% of Klebsiella isolates were multidrug resistant (MDR); which was again predominant in COVID negative group. 85.71% of E.Coli infection occurred in COVID positive group and none were MDR. The similar findings were present for Acinetobacter where 83.33% occurred in COVID positive group. 50% of Acinetobacter isolates were MDR and most commonly distributed in COVID positive group (66.66%). The present study was done as a pilot study as described above. In this small sample size no statistical tests were performed for calculation of significance. The results are mainly tabulated as a proportion. The most common organism found was Klebsiella. Acinetobacter was also found in few patients. But most striking finding was that COVID positive patients showed higher incidence of antibiotic resistance with Acinetobacter. Though E Coli was also found commonly in COVID positive patients, they were not drug resistant. The significance of such findings may be revealed in the bigger study planned subsequently with the same protocol. The observation of drug resistant state by each and individual bacteria in COVID positive and COVID negative patients will be an interesting finding to note; such observation may guide as to plan antibiotic therapy in COVID patients. The scientific evidences of such data are lacking still. Previously a Spanish study on 24 subjects found most common isolates were S. aureus, S. pneumoniae, and H.influenzae [9] . Other studies also showed most common isolate was S.pneumoniae [10] [11] [12] [13] . A furthervery small study among COVID-19 patients in ICU in Iran reported bacterial co-infection in all cases, most commonly due to Acinetobacter baumanii and possibly really representing super-infections [14] . So the organisms may vary from place to place and depend on the bacteriological profile present in a particular setup. But the data about antibiotic resistance patterns are not avidly available in COVID positive patients. Conclusion: MDR infections are common in COVID patients. Acinetobacter and Klebsiella are prone to develope MDR infections. While E.Coli is also common in COVID patients, chance of drug resistance is less among them. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted September 15, 2021. ; https://doi.org/10.1101/2021.09.12.21263386 doi: medRxiv preprint The role of co-infections and secondary infections in patients with COVID-19 Viral respiratory infections: a cause of communityacquired pneumonia or a predisposing factor? SARS-CoV-2, bacterial co-infections, and AMR: the deadly trio in COVID-19? Molecular pathogenesis of secondary bacterial infection associated to viral infections including SARS-CoV-2 The novel coronavirus COVID-19 outbreak: global implications for antimicrobial resistance Collateral damage of the COVID-19 pandemic: exacerbation of antimicrobial resistance and disruptions to antimicrobial stewardship programmes? S SARS-CoV-2, bacterial co-infections, and AMR: the deadly trio in COVID-19? How covid-19 is accelerating the threat of antimicrobial resistance High rate of infections during ICU admission of patients with severe SARS-CoV-2 pneumonia: A matter of time? Case report: the importance of novel coronavirus disease (COVID-19) and coinfection withother respiratory pathogens in the current pandemic First COVID-19 infections in the Philippines: a case report Nicolás D; hospital Clínic 4H team. Pneumococcal superinfection in COVID-19 patients: a series of 5 cases Coinfection with respiratory pathogens among COVID-19 cases Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU This study was approved (on 01.07.2021) by Institutional Ethics Committee