Evaluation of bi-lateral co-infections and antibiotic resistance rates among COVID-19 patients

Naveed Ahmed, Madiha Khan, Waqas Saleem, Mohmed Isaqali Karobari, Roshan Noor Mohamed, Artak Heboyan, Ali A. Rabaan, Abbas Al Mutair, Saad Alhumaid, Salman A. Alsadiq, Ahmed S. Bueid, Eman Y. Santali, Jeehan H. Alestad

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In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p < 0.05) was noted between the hospitalized COVID-19 patients and bacterial co-infections. Staphylococcus aureus (S. aureus) showed high resistance against tetracycline (61.7%), Streptococcus pyogenes against penicillin (100%), E. coli against Amp-clavulanic acid (88.72%), Klebsiella pneumoniae against ampicillin (100%), and Pseudomonas aeruginosa against ciprofloxacin (75.40%). Acinetobacter baumannii was 100% resistant to the majority of tested antibiotics. The prevalence of methicillin-resistant S. aureus (MRSA) was 14.7%. The topmost symptoms of > 50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended.

Original languageEnglish
Article number276
Number of pages12
Issue number2
Early online date19 Feb 2022
Publication statusPublished - 19 Feb 2022


  • COVID-19
  • antimicrobial resistance
  • antimicrobial stewardship
  • co-infections
  • hospital-acquired infections
  • SARS-CoV-2


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