Predictors of Severity and Co-Infection Resistance Profile in COVID-19 Patients: First Report from Upper Egypt

• Published in: Infection and drug resistance Vol. 13; pp. 3409 - 3422
• Main Authors: Ramadan, Haidi Karam-Allah, Mahmoud, Manal A, Aburahma, Mohamed Zakaria, Elkhawaga, Amal A, El-Mokhtar, Mohamed A, Sayed, Ibrahim M, Hosni, Amal, Hassany, Sahar M, Medhat, Mohammed A
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2020; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Antimicrobial resistance; Beta lactamases; clinical characteristics; Coronary artery disease; Coronaviridae; Coronaviruses; Cough; COVID-19; Diabetes mellitus; disease severity; Drug resistance; Dyspnea; esbl; Ferritin; Fever; Fungi; Health aspects; Heart diseases; Ischemia; kpc; Lymphopenia; MecA protein; Medical research; Methicillin; Microbial drug resistance; Mortality; Multidrug resistance; Mycoses; ndm-1; Original Research; Pandemics; Patients; Respiration; Risk factors; Severe acute respiratory syndrome coronavirus 2; Staphylococcal infections; upper egypt; United Kingdom; China; Egypt; United States > US; COVID-19; NDM-1; risk factors; ESBL; Upper Egypt; disease severity; clinical characteristics; KPC
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S272605

The emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide devastating effect with a diagnostic challenge. Identifying risk factors of severity aids in assessment for the need of early hospitalization. We aimed to demonstrate, for the first time, the clinical, laboratory and radiological characteristics of coronavirus disease 2019 (COVID-19) patients, to identify the predictors of severity and to describe the antimicrobial resistance profile in patients from Upper Egypt. Demographic characters, clinical presentations, laboratory, and radiological data were recorded and analyzed. Presence of other respiratory microorganisms and their sensitivity patterns were identified using the VITEK2 system. Resistance-associated genes were tested by PCR. The study included 260 COVID-19 patients. The majority were males (55.4%) aged between 51 and 70 years. Hypertension, diabetes, and ischemic heart disease were common comorbidities. Main clinical manifestations were fever (63.8%), cough (57.7%), dyspnea (40%) and fatigue (30%). According to severity, 51.5% were moderate, 25.4% mild and 23% severe/critical. Lymphopenia, elevated CRP, ferritin, and D-dimer occurred in all patients with significantly higher value in the severe group. Age >53 years and elevated ferritin ≥484 ng/mL were significant risk factors for severity. About 10.7% of the COVID-19 patients showed bacterial and/or fungal infections. , and were the predominant isolated bacteria while and were the predominant isolated fungi. All Staphylococci were methicillin-resistant and carried the gene. Gram-negative isolates were multidrug-resistant and carried different resistance-associated genes, including , and Older age and elevated serum ferritin were significant risk factors for severe COVID-19. Bacterial co-infection and multidrug resistance among patients with COVID-19 in Upper Egypt is common. Testing for presence of other co-infecting agents should be considered, and prompt treatment should be carried out according to the antimicrobial sensitivity reports.